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Sample records for percutaneous endovascular aneurysm

  1. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  2. Treatment of Infected Aneurysms of the Abdominal Aorta and Iliac Artery with Endovascular Aneurysm Repair and Percutaneous Drainage.

    PubMed

    Chino, Shuji; Kato, Noriyuki; Noda, Yoshihiro; Oue, Kensuke; Tanaka, Satofumi; Hashimoto, Takashi; Higashigawa, Takatoshi; Miyake, Yoichiro; Okabe, Manabu

    2016-10-01

    Infected aneurysm remains one of the most challenging diseases for vascular surgeons. We describe the successful treatment of 2 cases of infected aneurysms with endovascular aneurysm repair and percutaneous computed tomography-guided drainage. This strategy may be an effective alternative to open surgical repair in selected patients.

  3. Percutaneous versus Femoral Cutdown Access for Endovascular Aneurysm Repair

    PubMed Central

    Buck, Dominique B.; Karthaus, Eleonora G.; Soden, Peter A.; Ultee, Klaas H. J.; van Herwaarden, Joost A.; Moll, Frans L.; Schermerhorn, Marc L.

    2015-01-01

    Objective Prior studies suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (pEVAR) offers significant operative and post-operative benefits compared to femoral cutdown (cEVAR). National data on this topic, however, are limited. We compared patient selection and outcomes for elective pEVAR and cEVAR. Methods We identified all patients undergoing either pEVAR (bilateral percutaneous access whether successful or not) or cEVAR (at least one planned groin cutdown) for abdominal aortic aneurysms (AAA), from January 2011 to December 2013 in the Targeted Vascular dataset from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Emergent cases, ruptures, cases with an iliac conduit, and cases with a preoperative wound infection were excluded. Groups were compared using chi-square test or t-test or the Mann-Whitney test where appropriate. Results 4112 patients undergoing elective EVAR were identified; 3004 cEVAR (73%) and 1108 pEVAR (27%). Of all EVAR patients 26% had bilateral percutaneous access, 1.0% had attempted percutaneous access converted to cutdown (4% of pEVARs), while the remainder had a planned cutdown, 63.9% bilateral, and 9.1% unilateral. There were no significant differences in age, gender, aneurysm diameter or prior open abdominal surgery. Patients undergoing cEVAR were less likely to have congestive heart failure (1.5% vs. 2.4%, P=0.04) but more likely to undergo any concomitant procedure during surgery (32% vs. 26%, P<.01) than patients undergoing pEVAR. Postoperatively, pEVAR patients had shorter operative time (mean 135 vs. 152 minutes, P<.01), shorter length of stay (median 1 day vs. 2 days, P<.01), and fewer wound complications (2.1% vs. 1.0%, P=0.02). On multivariable analysis the only predictor of percutaneous access failure was performance of any concomitant procedure (OR 2.0, 95% CI 1.0–4.0, P=0.04). Conclusions Currently, 1 in 4 patients treated at Targeted Vascular

  4. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  5. Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR)

    SciTech Connect

    Lagana, Domenico Mangini, Monica Fontana, Federico; Nicotera, Paolo; Carrafiello, Gianpaolo; Fugazzola, Carlo

    2009-01-15

    The purpose of this study was to assess the feasibility and effectiveness of percutaneous endovascular repair of ruptured abdominal aortic aneurysms (AAAs) previously treated by EVAR. In the last year, two male patients with AAAs, treated 8 and 23 months ago with bifurcated stent-graft, were observed because of lumbar pain and hemorragic shock. Multidetector computed tomography (MDCT) showed a retroperitoneal hematoma; in both cases a type III endoleak was detected, in one case associated with a type II endoleak from the iliolumbar artery. The procedures were performed in the theater, in emergency. Type II endoleak was treated with transcatheter superselective glue injection; type III endoleaks were excluded by a stent-graft extension. The procedures were successful in both patients, with immediate hemodynamic stabilization. MDCT after the procedure showed complete exclusion of the aneurysms. In conclusion, endovascular treatment is a safe and feasible option for the treatment of ruptured AAAs previously treated by EVAR; this approach allows avoidance of surgical conversion, which is technical very challenging, with a high morbidity and mortality rate.

  6. Combined Laparoscopic and Percutaneous Treatment of a Type II Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Karkos, Christos D. Hayes, Paul D.; Lloyd, David M.; Fishwick, Guy; White, Steve A.; Quadar, Salman; Sayers, Robert D.

    2005-06-15

    We describe a novel approach in treating a persistent type II endoleak related to the inferior mesenteric artery (IMA) and the lower lumbar arteries. The endoleak failed to thrombose following percutaneous IMA coil embolization. We proceeded to one-stage laparoscopic IMA division and intra-sac thrombin injection under direct laparoscopic vision and fluroscopy. A CT scan at 1 and 7 months post-intervention showed no evidence of endoleak and the growth of the aneurysm was arrested. This combined laparoscopic and percutaneous approach may be a useful treatment option in the management of persistent complex type II endoleak. Its durability, however has yet to be defined.

  7. Combined laparoscopic and percutaneous treatment of a type II endoleak following endovascular abdominal aortic aneurysm repair.

    PubMed

    Karkos, Christos D; Hayes, Paul D; Lloyd, David M; Fishwick, Guy; White, Steve A; Quadar, Salman; Sayers, Robert D

    2005-01-01

    We describe a novel approach in treating a persistent type II endoleak related to the inferior mesenteric artery (IMA) and the lower lumbar arteries. The endoleak failed to thrombose following percutaneous IMA coil embolization. We proceeded to one-stage laparoscopic IMA division and intra-sac thrombin injection under direct laparoscopic vision and fluroscopy. A CT scan at 1 and 7 months post-intervention showed no evidence of endoleak and the growth of the aneurysm was arrested. This combined laparoscopic and percutaneous approach may be a useful treatment option in the management of persistent complex type II endoleak. Its durability, however has yet to be defined.

  8. Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia.

    PubMed

    Ioannou, C V; Kontopodis, N; Kehagias, E; Papaioannou, A; Kafetzakis, A; Papadopoulos, G; Pantidis, D; Tsetis, D

    2015-07-01

    To present our experience with the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA) during endovascular aneurysm repair (EVAR) and compare results according to the type of anaesthesia. We conducted a single-centre retrospective study including patients who underwent EVAR using the Ovation endograft between May 2011 and July 2014. Outcome was evaluated regarding pre-, peri- and immediate postoperative and follow-up measures. Overall results are reported, while additional analysis was performed to compare the outcome between groups of patients undertaking either local or regional/general anaesthesia (LA vs RGA). 66 patients were included. Median follow-up was 13 months (range, 1-39 months). Median age was 72 years and median abdominal aortic aneurysm diameter was 58 mm (range, 54-100 mm). Technical success was 63 (95%), while there were 2 (3%) conversions to open surgery. A total percutaneous approach was used in 50/66 (76%) cases. Overall, 9/66 (14%) subjects suffered from any kind of morbidity. Median hospitalization was 3 days (range, 1-16 days). Immediate and midterm mortality rate was 0%. No endoleak Type I, III, IV or stent migration was observed. There were 8 (13%) Type II endoleaks. Overall, additional endovascular procedures were required in 6 (9%), while surgery was performed in 4 (6%) patients. 44 (67%) patients underwent LA and 22 (23%) RGA. Differences between groups were significant for procedural time (85 vs 107 min; p < 0.001), percutaneous access (91% vs 45%; p < 0.001) and systematic complications (2.3% vs 14%; p = 0.05). EVAR with the use of the Ovation endograft shows promising short-term and midterm results regarding safety and effectiveness. Completion of the procedures under LA using a total percutaneous approach seems advantageous and may be used in routine practice. The Ovation Abdominal Stent Graft System is an ultra-low profile stent graft system that allows percutaneous deployment for EVAR and

  9. Endovascular management of pediatric aneurysms.

    PubMed

    Saleh, E; Dawson, R C

    2011-10-31

    Although the general principles of endovascular aneurysm treatment in adults hold true in children, these young patients pose unique challenges: small anatomy, longer life expectancy, associated conditions and morphological characteristics of the aneurysms. Few publications in the literature address the role of endovascular treatment for pediatric aneurysms; including series by Agid et al. (2005) (1) revisiting the Toronto series, Lasjaunias et al. (2005) (2) updating the Bicêtre series and Sanai et al (2006) (8) presenting the San Francisco series. In their conclusions, the authors of the former two publications favored endovascular treatment over microsurgery. On the other hand, the authors of the latter publication favored microsurgery over endovascular treatment. The authors reviewed Louisiana State University experience regarding endovascular treatment of pediatric aneurysms focusing on outcomes. A retrospective chart review was performed of children under 18, who underwent endovascular treatment for intracranial aneurysms between 2000 and 2009 in our institution. Twelve patients harboring seventeen aneurysms were identified. The patients ranged in age from seventeen months to seventeen years. Complete aneurysm obliteration following endovascular treatment was around 95%. Our results showed unique features for pediatric aneurysms when compared to adult aneurysms. No intra operative mortality was recorded. One aneurysm recurred (5% recurrence rate among total number of aneurysms). In this case, six months after treatment, a control angiogram showed that the coils were displaced toward the dome of the aneurysm. This recurrence occurred before the introduction of the hydro coils. One patient died during the post intervention period (8% occurrence rate among total number of patients). Outcomes were better in anterior circulation aneurysms than in posterior circulation lesions. We had no mortality, morbidity or disability in the anterior circulation aneurysm group

  10. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial).

    PubMed

    Nelson, Peter R; Kracjer, Zvonimir; Kansal, Nikhil; Rao, Vikram; Bianchi, Christian; Hashemi, Homayoun; Jones, Paul; Bacharach, J Michael

    2014-05-01

    The first multicenter randomized controlled trial was designed and conducted to assess the safety and effectiveness of totally percutaneous endovascular aortic aneurysm repair (PEVAR) with use of a 21F endovascular stent graft system and either an 8 F or 10 F suture-mediated closure system (the PEVAR trial, NCT01070069). A noninferiority trial design was chosen to compare percutaneous access with standard open femoral exposure. Between 2010 and 2012, 20 U.S. institutions participated in a prospective, Food and Drug Administration-approved randomized trial to evaluate percutaneous femoral artery access and closure by a "preclose" technique in conjunction with endovascular abdominal aortic aneurysm repair. A total of 151 patients were allocated by a 2:1 design to percutaneous access/closure (n = 101) or open femoral exposure (n = 50 [FE]). PEVAR procedures were performed with either the 8 F Perclose ProGlide (n = 50 [PG]) or the 10 F Prostar XL (n = 51 [PS]) closure devices. All endovascular abdominal aortic aneurysm repair procedures were performed with the Endologix 21 F profile (outer diameter) sheath-based system. Patients were screened by computed tomography with three-dimensional reconstruction and independent physician review for anatomic suitability and adequate femoral artery anatomy for percutaneous access. The primary trial end point (treatment success) was defined as procedural technical success and absence of major adverse events and vascular complications at 30 days. An independent access closure substudy evaluated major access-related complications. Clinical utility and procedural outcomes, ankle-brachial index, blood laboratory analyses, and quality of life were also evaluated with continuing follow-up to 6 months. Baseline characteristics were similar among groups. Procedural technical success was 94% (PG), 88% (PS), and 98% (FE). One-month primary treatment success was 88% (PG), 78% (PS), and 78% (FE), demonstrating noninferiority vs FE for PG (P

  11. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    SciTech Connect

    Patel, Rafiuddin; Juszczak, Maciej T.; Bratby, Mark J.; Sideso, Ediri; Anthony, Susan; Tapping, Charles R.; Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy; Uberoi, Raman

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  12. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... MRI scan Aortic aneurysm repair - endovascular Aortic angiography Hardening of ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla ...

  13. Endovascular treatment of blister aneurysms.

    PubMed

    Peitz, Geoffrey W; Sy, Christopher A; Grandhi, Ramesh

    2017-06-01

    Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative. Among endovascular treatment options, deconstructive treatment has been associated with higher morbidity compared with reconstructive methods such as direct embolization, stent- or balloon-assisted direct embolization, stent monotherapy, and flow diversion. Flow diversion has been associated with higher technical success rates and similar clinical outcomes compared with non-flow diverting treatment methods. However, delayed aneurysm occlusion and the need for antiplatelet therapy are potential drawbacks to flow diversion that must be considered when choosing among treatment methods for blister aneurysms.

  14. Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair: A Meta-analysis.

    PubMed

    Cao, Zhanjiang; Wu, Weiwei; Zhao, Keqiang; Zhao, Junlai; Yang, Yu; Jiang, Chao; Zhu, Rongrong

    2017-04-01

    To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference -24.52, 95% CI -46.45 to -22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.

  15. Techniques in Endovascular Aneurysm Repair

    PubMed Central

    Phade, Sachin V.; Garcia-Toca, Manuel; Kibbe, Melina R.

    2011-01-01

    Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies. PMID:22121487

  16. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives

    PubMed Central

    Orr, Nathan; Minion, David; Bobadilla, Joseph L

    2014-01-01

    Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered. PMID:25170271

  17. Bronchial Aneurysms Mimicking Aortic Aneurysms: Endovascular Treatment in Two Patients

    SciTech Connect

    Vernhet, Helene; Bousquet, Claudine; Jean, Betty; Lesnik, Alvian; Durand, Gerard; Giron, Jacques; Senac, Jean Paul

    1999-05-15

    Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

  18. Endovascular exclusion of patch aneurysms of intercostal arteries after thoracoabdominal aortic aneurysm repair.

    PubMed

    Juthier, Francis; Rousse, Natacha; Banfi, Carlo; Beregi, Jean-Paul; Vincentelli, André; Prat, Alain; Bachet, Jean

    2013-02-01

    Reimplantation of the largest patent intercostal arteries is usually performed during thoracoabdominal aortic aneurysm repair. This may lead to aneurysmal evolution of the intercostal arteries patch. We report the successful percutaneous endovascular repair in 4 Marfan patients of aneurysms of the intercostal arteries patch that developed after thoracoabdominal aortic aneurysm repair (Crawford type II) during a mean delay of 70 months (range, 48 to 91 months). All patients had previously undergone one or several aortic surgical procedures and had patent subclavian and hypogastric arterial networks. No in-hospital deaths or spinal cord ischemic injuries occurred, which emphasizes the importance of the vascular collateral network.

  19. Endovascular management of vertebrobasilar artery dissecting aneurysms.

    PubMed

    Wang, Jian; Sun, Zhigang; Bao, Jinsuo; Li, Zhaohui; Bai, Dongsong; Cao, Shuwei

    2013-01-01

    The prognosis of VBA aneurysms seems poor and surgical management of VBA dissecting aneurysms is challenging. We evaluated our endovascular experience in management of ruptured and unruptured VBA dissecting aneurysms. Eleven consecutive patients with eleven VBA aneurysms (3 ruptured and 8 unruptured) between 2008 and 2010 were retrospectively reviewed. Immediate postprocedural angiograms showed complete occlusion in 5 and subtotal occlusion in 2 aneurysms treated with stentassisted coiling, whereas no occlusion in 4 aneurysms treated with stenting alone. A clinical improvement or stable outcome was achieved in all patients. There was no complication in our patients and no patient died after treatment. Angiographic follow-up (mean 9.7 months, 1 to 23 months) showed complete cure in 8 aneurysms, subtotal occlusion in 2 and no occlusion in 1. VBA dissecting aneurysms can be managed by endovascular stent placement with or without coiling. In cases that cannot be treated with neurostents, proximal occlusion could be an option.

  20. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  1. Midterm experience with the endovascular treatment of isolated iliac aneurysms.

    PubMed

    Casana, R; Nano, G; Dalainas, I; Stegher, S; Bianchi, P; Tealdi, D G

    2003-03-01

    The aim of this retrospective, single institution study was to describe our 4-year experience with the endovascular repair of isolated iliac artery aneurysms. Between May 1997 and June 2001, 16 patients (15 males; mean age 64+/-9 years), were treated with covered stent grafts. Twelve of the endovascular procedures were performed under epidural and 4 under local anaesthesia. The percutaneous approach was employed in 13 cases and the femoral artery had to be exposed in 3 cases that demanded simultaneous revascularization of the peripheral circulation (n=2) or required a 16 F sheath to employ a Baxter Lifepath stent graft (n=1). The mean size of the iliac aneurysms was 4.5 cm (range 3.5 to 5.2 cm). Four aneurysms involved the hypogastric ostium in absence of any distal neck. All the patients underwent initially successful endovascular treatment of isolated iliac aneurysms and were followed from 3 to 52 months (mean 18 months). No procedural deaths and no acute or late graft thrombosis occurred. The perioperative complications included 1 dissection of the external iliac artery that required a further endovacular procedure and 1 case of endovascular leak fed to the hypogastric artery. A CT scan 4 months later showed spontaneous thrombosis of aneurysm and no further leakage. Two patients had undergone combinated femoro-popliteal arterial bypass. In our early clinical experience the use of self-expandable covered stent graft successful treated isolated iliac artery aneurysms. Endovascular repair is a safe and effective technique with good midterm results in patients at standard and high risk.

  2. Surgery of intracranial aneurysms previously treated endovascularly.

    PubMed

    Tirakotai, Wuttipong; Sure, Ulrich; Yin, Yuhua; Benes, Ludwig; Schulte, Dirk Michael; Bien, Siegfried; Bertalanffy, Helmut

    2007-11-01

    To perform a retrospective study on the patients who underwent aneurysmal surgery following endovascular treatment. We performed a retrospective study on eight patients who underwent aneurysmal surgery following endovascular treatment (-attempts) with gugliemi detachable coils (GDCs). The indications for surgery, surgical techniques and clinical outcomes were analyzed. The indications for surgical treatment after GDC coiling of aneurysm were classified into three groups. First group: surgery of incompletely coiled aneurysms (n=4). Second group: surgery of mass effect on the neural structures due to coil compaction or rebleeding (n=2). Third group: surgery of vascular complications after endovascular procedure due to parent artery occlusion or thrombus propagation from aneurysm (n=2). Aneurysm obliterations could be performed in all cases confirmed by postoperative angiography. Six patients had an excellent outcome and returned to their profession. Patient's visual acuity was improved. One individual experienced right hemiparesis (grade IV/V) and hemihypesthesia. Microsurgical clipping is rarely necessary for previously coiled aneurysms. Surgical treatment is uncommonly required when an acute complication arises during endovascular treatment, or when there is a dynamic change of a residual aneurysm configuration over time that is considered to be insecure.

  3. Emergency endovascular treatment of popliteal aneurysms.

    PubMed

    Saratzis, Athanasios; Melas, Nikolaos; Dixon, Hannah; Saratzis, Nikolaos

    2010-12-01

    Popliteal artery aneurysm (PAA), despite being rare, is the most common peripheral aneurysm. It can present as acute thrombosis and occlusion of the aneurysmal segment, and distal embolization, causing either chronic or acute limb ischemia. It has traditionally been treated with open surgical reconstruction. Endovascular repair of PAAs has recently been applied electively with a favourable early and mid-term outcome; however there is a lack of reports on the endovascular treatment of PAAs presenting with acute complications. This report describes the treatment of a thrombosed PAA in a 58 year old male using an endovascular stent-graft and also provides a systematic review of the literature on the emergency endovascular treatment of PAAs.

  4. Multiple Intracranial Aneurysms: Endovascular Treatment and Complications

    PubMed Central

    Shen, Xun; Xu, Tao; Ding, Xuan; Wang, Wenlei; Liu, Zhi; Qin, Huaihai

    2014-01-01

    Summary This study evaluated the results of endovascular embolization of multiple intracranial aneurysms. A retrospective hospital chart and radiograph review were made of all patients with multiple intracranial aneurysms seen between March 2010 and January 2011. Ten patients presented with subarachnoid hemorrhage, four with mass effect, two with brain ischemia and twenty were incidental. These 36 patients harbored 84 aneurysms, 63 of which were treated with endovascular techniques, two by surgical clipping, and 19 were left untreated. Of the coil-treated lesions, a complete endovascular occlusion was achieved in 54 aneurysms (85.7%), and eight (12.7%) presented neck remnants with one (1.6%) stented only. Twenty-six patients (72.2%) underwent coil embolization of more than one aneurysm in the first session. Follow-up angiographic studies in 31 patients demonstrated an unchanged or improved result in 93.0% of the aneurysms (53 lesions) and coil compaction in 7.0% (four lesions). The overall clinical outcome was excellent in 33 patients (91.7%), good in one (2.8%) and fair in two (5.5%). Endovascular techniques may be a particularly suitable method for treating multiple intracranial aneurysms. PMID:25207907

  5. Endovascular Aneurysm Repair: Current and Future Status

    SciTech Connect

    Hinchliffe, R. J. Ivancev, K.

    2008-05-15

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

  6. Complications of endovascular treatment of cerebral aneurysms.

    PubMed

    Orrù, Emanuele; Roccatagliata, Luca; Cester, Giacomo; Causin, Francesco; Castellan, Lucio

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  7. [Endovascular treatment of giant intracranial aneurysms].

    PubMed

    Bracard, S; Derelle, A L; Tonnelet, R; Barbier, C; Proust, F; Anxionnat, R

    2016-02-01

    Giant aneurysms are defined as having a maximal diameter higher than 25mm. The dynamic aspect of giant aneurysms, in particular, is its growth, which was responsible for parenchyma sequellae either due to haemorrhagic complications or a compression of cranial nerves. The treatment of these giant aneurysms was challenging because of its size, the mass effect and the neck diameter. These morphologic conditions required complex endovascular procedures such as remodelling, stenting, using flow diverters. Subsequently, the complex procedures increased the risk of morbidity because of ischemic complications. Despite these procedures, the risk of recurrence was high.

  8. Endovascular Treatment of Internal Iliac Artery Aneurysms: Single Center Experience

    PubMed Central

    Machado, Rui Manuel; Rego, Duarte Nuno Cunha; de Oliveira, Pedro Nuno Ferreira Pinto; de Almeida, Rui Manuel Gonçalves Fernandes

    2016-01-01

    Objective Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all. PMID:27556311

  9. Endovascular Treatment of Giant Splenic Artery Aneurysm

    PubMed Central

    Góes Junior, Adenauer Marinho de Oliveira; Góes, Amanda Silva de Oliveira; de Albuquerque, Paloma Cals; Palácios, Renato Menezes; Abib, Simone de Campos Vieira

    2012-01-01

    Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5 cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2 cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered “high risk” for surgical treatment by laparotomy/laparoscopy. PMID:23316410

  10. Insights on a Giant Aneurysm Treated Endovascularly.

    PubMed

    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries.

  11. [Endovascular treatment of descending thoracic aorta aneurysm].

    PubMed

    Mertens, Renato; Valdés, Francisco; Krämer, Albrecht; Mariné, Leopoldo; Irarrázaval, Manuel; Morán, Sergio; Zalaquet, Ricardo; Schwartz, Eitan; Vergara, Jeannette; Valdebenito, Magaly

    2003-06-01

    The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. To report our experience with endovascular treatment of thoracic aorta aneurysms. Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Gore) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery.

  12. Comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair for abdominal aortic aneurysm

    PubMed Central

    Gottsäter, Anders; Acosta, Stefan

    2014-01-01

    Objective: To evaluate mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and standard endovascular aneurysm repair for abdominal aortic aneurysm. Methods: Consecutive patients treated from 2007 to 2011 with elective fenestrated endovascular aneurysm repair (n = 81) and endovascular aneurysm repair (n = 201) were evaluated concerning age, cardiovascular medication, comorbidities, and mid-term mortality. Results: Patients in the elective fenestrated endovascular aneurysm repair group were younger than the endovascular aneurysm repair group (p = 0.006). In comparison with the endovascular aneurysm repair group, a lower proportion of patients in the elective fenestrated endovascular aneurysm repair group had diabetes (p = 0.013) and anemia (p = 0.003), and a higher proportion had arterial hypertension (p = 0.009). When entering age, endovascular aneurysm repair or fenestrated endovascular aneurysm repair operation, diabetes, anemia, and hypertension in a Cox regression model, only age (hazard ratio: 1.07; 95% confidence interval: 1.03–1.11; p < 0.001) was a risk factor for mid-term mortality. Conclusion: Careful patient selection and medical optimization resulted in comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair. PMID:26770700

  13. Endovascular Repair of Abdominal Aortic Aneurysms

    PubMed Central

    Sternbergh, W. Charles; Yoselevitz, Moises; Money, Samuel R.

    1999-01-01

    Endovascular treatment of abdominal aortic aneurysms (AAAs) is an exciting new minimally invasive treatment option for patients with this disease. Ochsner Clinic has been the only institution in the Gulf South participating in FDA clinical trials of these investigational devices. Early results with endovascular AAA repair demonstrate a trend towards lower mortality and morbidity when compared with traditional open surgery. Length of stay has been reduced by two-thirds with a marked reduction in postoperative pain and at-home convalescence. If the long-term data on efficacy and durability of these devices are good, most AAAs in the future will be treated with this minimally invasive technique. PMID:21845135

  14. Endovascular Techniques for the Treatment of Renal Artery Aneurysms

    SciTech Connect

    Elaassar, Omar Auriol, Julien; Marquez, Romero; Tall, Philippe; Rousseau, Herve; Joffre, Francis

    2011-10-15

    Purpose: Our goal was to analyze the indications and limitations of the different percutaneous endovascular approaches reported for the treatment of renal artery aneurysms (RAAs) and to develop a scientific approach for optimum selection of treatment strategy of RAAs through analyzing our experience and reviewing available literature. Methods: This retrospective study was designed to evaluate the treatment and follow-up of 13 consecutive patients who presented with 13 RAAs by using a variety of endovascular interventional techniques. Different combinations of coil embolization, liquid embolization, stenting, and stent-graft exclusion were used in correlation with variable-specific aneurysm criteria. Results: All patients were successfully treated with no significant short- or long-term complications. Patients were followed for an average period of 43 (range 13-103) months. Conclusions: Ten different determinants were found to affect our decision making: shape, size, neck, position of aneurysm on artery, branches arising, artery involved, condition of the artery, age, general condition of the patient, and renal function.

  15. Endovascular Management of Thoracic Aortic Aneurysms

    SciTech Connect

    Fattori, Rossella Russo, Vincenzo; Lovato, Luigi; Buttazzi, Katia; Rinaldi, Giovanni

    2011-12-15

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  16. Endovascular treatment of abdominal aortic aneurysms

    PubMed Central

    Buck, Dominique B.; van Herwaarden, Joost A.; Schermerhorn, Marc L.; Moll, Frans L.

    2014-01-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  17. Endovascular Exclusion of Mycotic Aortic Aneurysm

    PubMed Central

    Takach, Thomas J.; Kane, Peter N.; Madjarov, Jeko M.; Holleman, Jeremiah H.; Robicsek, Francis; Roush, Timothy S.

    2007-01-01

    The presence of prohibitive risk may preclude usual surgical management. Such was the case for a critically ill, 60-year-old woman who presented with concomitant, life-threatening conditions. The patient presented with acute central cord syndrome and lower-extremity paraplegia after completing a 6-week course of intravenous antibiotics for methicillin-sensitive Staphylococcus aureus bacteremia and osteomyelitis of the thoracic spine. Radiologic examination revealed bony destruction of thoracic vertebrae T4 through T6, impingement on the spinal cord and canal by an inflammatory mass, and a separate 2.5-cm mycotic aneurysm of the infrarenal aorta. The clinical and radiologic findings warranted immediate decompression and stabilization of the spinal cord, aneurysmectomy, and vascular reconstruction. However, the severely debilitated patient could not tolerate 2 simultaneous open procedures. She underwent emergent endovascular exclusion of the mycotic aneurysm with a stent-graft, followed immediately by laminectomy and stabilization of the thoracic spine. Intraoperative microbiology specimens showed no growth. The patient was maintained on prophylactic antibiotic therapy for 6 months. Fourteen months postoperatively, her neurologic function was near full recovery, and neither surveillance blood cultures nor radiologic examinations showed a recurrence of infection or aneurysm. Although the long-term outcome of endovascular stent-grafts in the treatment of culture-negative mycotic aneurysms is unknown, the use of these grafts in severely debilitated patients can reduce operative risk and enable recovery in the short term. PMID:18172531

  18. The Endovascular Management of Iliac Artery Aneurysms

    SciTech Connect

    Stroumpouli, Evangelia; Nassef, Ahmed; Loosemore, Tom; Thompson, Matt; Morgan, Robert; Belli, Anna-Maria

    2007-11-15

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

  19. Endovascular exclusion of a large external iliac vein aneurysm.

    PubMed

    Todorov, Mina; Hernandez, Diego

    2013-07-01

    Iliac vein aneurysms are uncommon, and there is no consensus on optimal treatment. We present a case of venous exclusion using an endovascular approach. To our knowledge, this is the first reported case of a large external iliac vein aneurysm treated endovascularly. We have demonstrated the feasibility of this approach with satisfactory 1-year follow-up. Copyright © 2013. Published by Elsevier Inc.

  20. Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

    PubMed Central

    Ko, Jun Kyeung; Kim, Hwan Soo; Choi, Hyuk Jin; Lee, Tae Hong; Yun, Eun Young

    2015-01-01

    Objective Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome. PMID:26539261

  1. Endovascular Repair of Abdominal Aortic Aneurysm

    PubMed Central

    2002-01-01

    EXECUTIVE SUMMARY The Medical Advisory Secretariat conducted a systematic review of the evidence on the effectiveness and cost-effectiveness of endovascular repair of abdominal aortic aneurysm in comparison to open surgical repair. An abdominal aortic aneurysm [AAA] is the enlargement and weakening of the aorta (major blood artery) that may rupture and result in stroke and death. Endovascular abdominal aortic aneurysm repair [EVAR] is a procedure for repairing abdominal aortic aneurysms from within the blood vessel without open surgery. In this procedure, an aneurysm is excluded from blood circulation by an endograft (a device) delivered to the site of the aneurysm via a catheter inserted into an artery in the groin. The Medical Advisory Secretariat conducted a review of the evidence on the effectiveness and cost-effectiveness of this technology. The review included 44 eligible articles out of 489 citations identified through a systematic literature search. Most of the research evidence is based on non-randomized comparative studies and case series. In the short-term, EVAR appears to be safe and comparable to open surgical repair in terms of survival. It is associated with less severe hemodynamic changes, less blood transfusion and shorter stay in the intensive care and hospital. However, there is concern about a high incidence of endoleak, requiring secondary interventions, and in some cases, conversion to open surgical repair. Current evidence does not support the use of EVAR in all patients. EVAR might benefit individuals who are not fit for surgical repair of abdominal aortic aneurysm and whose risk of rupture of the aneurysm outweighs the risk of death from EVAR. The long-term effectiveness and cost-effectiveness of EVAR cannot be determined at this time. Further evaluation of this technology is required. OBJECTIVE The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of endovascular repair of

  2. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    PubMed Central

    Choudhri, Omar; Mukerji, Nitin; Steinberg, Gary K.

    2013-01-01

    Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefited in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application of these two

  3. [Management of aortic aneurysms in the endovascular era].

    PubMed

    Gemayel, Gino; Montessuit, Michel; Sierra, Jorge; Lahlaidi Sierra, Nadia; Bednarkiewicz, Marek

    2017-03-01

    Abdominal aortic aneurysm is a disease seen in the elderly. Without intervention, an aneurysm can rupture which leads to death in most cases. Surgical resection was the gold standard treatment for many years but since two decades, endovascular repair has surged drastically. Less invasive and morbid than open repair, this technique has significantly evolved in the recent years. Nowadays the whole aorta can be treated with endovascular techniques in expert hands. This article presents an overview of different endovascular solutions and innovations in the management of aortic aneurysms.

  4. Intracranial pediatric aneurysms: endovascular treatment and its outcome.

    PubMed

    Saraf, Rashmi; Shrivastava, Manish; Siddhartha, Wuppalapati; Limaye, Uday

    2012-09-01

    The aim of this study was to analyze the location, clinical presentation, and morphological characteristics of pediatric aneurysms and the safety, feasibility, and durability of endovascular treatment. The authors conducted a retrospective study of all cases involving patients 18 years old or younger who underwent endovascular treatment for pediatric aneurysms at their institution between July 1998 and July 2010. The clinical presentation, aneurysm location, endovascular management, and treatment outcome were studied. During the study period, 23 pediatric patients (mean age 13 years, range 2 months-18 years) were referred to the authors' department and underwent endovascular treatment for aneurysms. The aneurysms were saccular in 6 cases, dissecting in 4, infectious in 5, and giant partially thrombosed lesions in 8. Fourteen of the aneurysms were ruptured, and 9 were unruptured. Thirteen were in the anterior circulation and 10 in the posterior circulation. The most common location in the anterior circulation was the anterior communicating artery; in the posterior circulation, the most common location was the basilar artery. Saccular aneurysms were the most common type in the anterior circulation; and giant partially thrombosed and dissecting aneurysms were the most common types in the posterior circulation. Coil embolization was performed in 7 cases, parent vessel sacrifice in 10, flow reversal in 3, glue embolization in 2, and stent placement in 1. Immediate angiographic cure was seen in 21 (91%) of 23 patients. Complications occurred in 4 patients, 3 of whom eventually had a good outcome. No patient died. Overall, a favorable outcome was seen in 22 (96%) of 23 patients. Follow-up showed stable occlusion of aneurysms in 96% of the patients. Pediatric aneurysms are rare. Their clinical presentation varies from intracranial hemorrhage to mass effect. They may also be found incidentally. Among pediatric patients with aneurysms, giant aneurysms are relatively common

  5. Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Citone, Michele; David, Vincenzo

    2008-01-15

    This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

  6. Microsurgical Clipping of Intracranial Aneurysms Following Unsuccessful Endovascular Treatment

    PubMed Central

    Yu, J.-L.; Xu, K.; Wang, H.-L.; Wang, B.; Luo, Q.

    2010-01-01

    Summary The purpose of the current study was to examine the reasons for failed endovascular aneurysm coiling and to determine the outcome of immediate microsurgical clipping. From July 2006 to July 2008, 198 patients underwent endovascular coiling at our institute; among them, ten cases were unsuccessful. All of the patients were diagnosed with intracranial aneurysms (ICAs) by cranial computed tomography angiography (CTA), and all underwent endovascular treatment without digital subtraction angiography (DSA). When endovascular coiling failed, the patients were immediately transferred to the operating room for microsurgical clipping under the same anesthetic. The ten patients were divided into three groups based on the cause of endovascular failure and associated clinical features. The clinical follow-up period was between 6-12 months, and all 10 patients had good outcomes following the surgery. Taken together, the results of this study suggest that immediate microsurgical clipping after failed endovascular coiling is efficient and may provide improved outcomes by preventing rebleeding. PMID:20377976

  7. Extended use of endovascular aneurysm sealing for ruptured abdominal aortic aneurysms.

    PubMed

    Böckler, Dittmar; Holden, Andrew; Krievins, Dainis; de Vries, Jean-Paul P M; Peters, Andreas S; Geisbüsch, Philipp; Reijnen, Michel

    2016-09-01

    Endovascular repair of abdominal aortic aneurysms (EVAR) is now an established treatment modality for suitable patients presenting with aneurysm rupture. EVAR for ruptured aneurysms reduces transfusion, mechanical ventilation, intensive care. and hospital stay when compared with open surgery. In the emergency setting, however, EVAR is limited by low applicability due to adverse clinical or anatomical characteristics and increased need for reintervention. In addition, ongoing bleeding from aortic side branches post-EVAR can cause hemodynamic instability, larger hematomas, and abdominal compartment syndrome. Endovascular aneurysm sealing, based on polymer filling of the aneurysm, has the potential to overcome some of the limitations of EVAR for ruptured aneurysms and to improve outcomes. Recent literature suggests that endovascular aneurysm sealing can be performed with early mortality similar to that of EVAR for ruptured aortic aneurysms, but experience is limited to a few centers and a small number of patients. The addition of chimney grafts can increase the applicability of endovascular aneurysm sealing in order to treat short-neck and juxtarenal aneurysms as an alternative to fenestrated endografts. Further evaluation of the technique, with larger longitudinal studies, is necessary before advocating wider implementation of endovascular aneurysm sealing in the emergency setting.

  8. Complications of Endovascular Repair of Abdominal Aortic Aneurysms: A Review

    SciTech Connect

    Katzen, Barry T. MacLean, Alexandra A.

    2006-12-15

    The endovascular procedure for repair of abdominal aortic aneurysms has had an enormous impact on the treatment of this challenging disease. Complications, however, do occur and it is important to have a thorough understanding of the array of complications and appropriate management strategies. In this review of endovascular complications, we describe early and late complications paying particular attention to preventive, treatment and surveillance strategies.

  9. Endovascular Treatment of Visceral Aneurysms and Pseudoaneurysms: Long-term Outcomes from a Multicenter European Study

    SciTech Connect

    Spiliopoulos, Stavros Sabharwal, Tarun; Karnabatidis, Dimitrios; Brountzos, Elias; Katsanos, Konstantinos; Krokidis, Miltiadis; Gkoutzios, Panagiotis; Siablis, Dimitrios; Adam, Andreas

    2012-12-15

    Purpose: To investigate the percutaneous endovascular management of visceral aneurysms (VA) and visceral pseudoaneurysms (VPA) treated in three European interventional radiology departments. Methods: Patient archives from the department's databases were examined and retrospectively analyzed. Patients diagnosed between 2000 and 2010 with VA and/or VPA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular methods, were included in the study. The study's primary end points were procedural technical success, target lesion reintervention rate, and periprocedural mortality rate. Secondary end points included major and minor complications rates. Results: The medical records of 54 patients (41 male, mean age 55 {+-} 18.1 years) with 58 VAs or VPAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, 21 VAs (mean diameter 49.4 {+-} 21 mm, range 20-100 mm) and 37 VPAs (mean diameter 25.1 {+-} 14.6 mm, range 8-60 mm) were treated. Procedural technical success was achieved in 100% of the cases, while target lesion reintervention rate was 6.1% (2 of 33) and 14.2% (3 of 21) in the VPA and VA groups, respectively. Mean clinical follow-up period was 19.1 {+-} 21.4 months. Overall periprocedural mortality rate was 3% (1 of 33) in the VPA group and 0% (0 of 21) in the VA group. Conclusion: Percutaneous endovascular treatment of VAs and VPAs is safe and effective with low morbidity and mortality. There is a small but significant reintervention rate, particularly for true aneurysms; dedicated follow-up imaging is recommended. Successful aneurysm exclusion was achieved in all cases with a second procedure.

  10. Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Renal Transplant

    SciTech Connect

    Rao, M.; Arya, N. Lee, B.; Hannon, R.J.; Loan, W.; Soong, C.V.

    2004-09-15

    Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.

  11. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    SciTech Connect

    Baldi, Sebastian Rostagno, Roman D.; Zander, Tobias; Llorens, Rafael; Schonholz, Claudio; Maynar, Manuel

    2008-03-15

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

  12. Endovascular Treatment of Basilar Artery Aneurysms Associated with Distal Fenestration

    PubMed Central

    Juszkat, R.; Nowak, S.; Moskal, J.; Kociemba, W.; Zarzecka, A.

    2009-01-01

    Summary Segmental non-fusion of the basilar artery results from failed fusion of the neural arteries and from regression of the bridging arteries that connect the longitudinal arteries. This condition is associated with aneurysm formation in 7% of cases. Distally unfused arteries with associated aneurysms are very rare. We report on a case of successful endovascular treatment of an aneurysm of the distally unfused basilar trunk. PMID:20465939

  13. Combined endovascular intervention and percutaneous thrombin injection in the treatment of iatrogenic pseudoaneurysm. Case report.

    PubMed

    Gabriel, M; Juszkat, R; Pukacki, F; Waliszewski, K

    2007-06-01

    One of the basic techniques of treatment of iatrogenic pseudoaneurysms is percutaneous thrombin injection. Unfortunately, success rate of this treatment can be limited in cases associated with extensive damage to arterial wall. Our paper presents one case of combined treatment involving endovascular occlusion of the entry to the false aneurysm and percutaneous thrombin injection into the pseudoaneurysm chamber. In our opinion this technique can be successfully applied in patients with contraindications for compression therapy, surgical intervention or failure of traditional injection due to large entry, multiple arterial wall damage or accompanying arteriovenous fistula.

  14. Endovascular Treatment of a Renal Artery Branch Aneurysm

    SciTech Connect

    Malacrida, G.; Dalainas, Ilias Medda, Massimo; Nano, Giovanni; Inglese, Luigi

    2007-02-15

    A 58-year-old woman was admitted to our institution because of a left renal artery branch saccular aneurysm with a 2 cm diameter. Due to a hostile abdomen and the infrarenal location, an endovascular approach was chosen. A Jostent Peripheral Stent-Graft was placed under angiographic control, excluding the aneurysm from the circulation. No peri- or postprocedural complications were observed. At 6 months follow-up, the endograft is patent, excluding the aneurysm. Endovascular treatment may represent an alternative to surgery, especially in the distal infraparenchymal location.

  15. Endovascular Treatment of Proximal Bilateral Iliac Limb Dislocation and Kinking following Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Alerci, Mario; Wyttenbach, Rolf Bogen, Marcel; Segesser, Ludwig K. von; Gallino, Augusto; Inglese, Luigi

    2005-05-15

    We report the case of a 69-year-old man with a late type 1b endoleak due to proximal migration of both iliac limbs 5 years after endovascular repair of an abdominal aortic aneurysm. The endovascular method used to correct bilaterally this condition is described. Final angiographic control shows patency of the stent-graft without signs of endoleak.

  16. Endovascular Repair of Descending Thoracic Aortic Aneurysm

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an assessment on endovascular repair of descending thoracic aortic aneurysm (TAA). Clinical Need Aneurysm is the most common condition of the thoracic aorta requiring surgery. Aortic aneurysm is defined as a localized dilatation of the aorta. Most aneurysms of the thoracic aorta are asymptomatic and incidentally discovered. However, TAA tends to enlarge progressively and compress surrounding structures causing symptoms such as chest or back pain, dysphagia (difficulty swallowing), dyspnea (shortness of breath), cough, stridor (a harsh, high-pitched breath sound), and hoarseness. Significant aortic regurgitation causes symptoms of congestive heart failure. Embolization of the thrombus to the distal arterial circulation may occur and cause related symptoms. The aneurysm may eventually rupture and create a life-threatening condition. The overall incidence rate of TAA is about 10 per 100,000 person-years. The descending aorta is involved in about 30% to 40% of these cases. The prognosis of large untreated TAAs is poor, with a 3-year survival rate as low as 25%. Intervention is strongly recommended for any symptomatic TAA or any TAA that exceeds twice the diameter of a normal aorta or is 6 cm or larger. Open surgical treatment of TAA involves left thoracotomy and aortic graft replacement. Surgical treatment has been found to improve survival when compared with medical therapy. However, despite dramatic advances in surgical techniques for performing such complex operations, operative mortality from centres of excellence are between 8% and 20% for elective cases, and up to 50% in patients requiring emergency operations. In addition, survivors of open surgical repair of TAAs may suffer from severe complications. Postoperative or postprocedural complications of descending TAA repair include paraplegia, myocardial infarction, stroke, respiratory failure, renal failure, and intestinal ischemia. The Technology Endovascular aortic aneurysm

  17. Intraarterial Thrombolysis for Thromboemboli Associated with Endovascular Aneurysm Coiling

    PubMed Central

    Koebbe, C.J.; Horowitz, M.B.; Levy, E.I.; Dutton, K.; Jungries, C.C.; Purdy, P.D

    2002-01-01

    Summary With the rapidly developing applications of GDC endovascular aneurysm embolization, the recognition and treatment of potential intra-procedural complications is crucial to reducing the morbidity and mortality of this procedure. Thromboembolic complications occur with an incidence of 2-11 % with endovascular aneurysm coiling. We describe five cases in which the intraarterial use of thrombolytics was applied to disrupt a fresh clot and recanalize the occluded vessels with variable angiographic and clinical success. Five cases are presented in which thromboembolic complications occurred during or shortly after GDC endovascular aneurysm occlusion. The complication was recognized while depositing coils in two cases, on post-embolization angiogram in one, and a few hours following embolization in two cases in which a new neurologic deficit developed in the ICU. In those cases recognized while the microcatheter was near the aneurysm site, immediate thrombolysis was performed at the site of occlusion. The patients who developed a new neurologic deficit were returned to the endovascular suite and the site of occlusion was noted to be distal to the coiled aneurysm. Clot disruption was performed with the microcatheter before delivering intraarterial thrombolytics. Thromboembolic complications of GDC aneurysm embolization are fortunately rare and can be managed with delivery of thrombolytic therapy at the site of occlusion. Intraarterial thrombolysis of fresh clot caused by GDC aneurysm occlusion can successfully open the occluded vessels but not without serious risk of hemorrhage. PMID:20594524

  18. Endovascular aneurysm repair for multiple aneurysms as a sequel of hypereosinophilic syndrome.

    PubMed

    McVeigh, T; Hynes, N; Tawfick, W; Sultan, S

    2014-04-01

    This case represents the first report of multiple arterial aneurysms including aortic, iliac, visceral, and coronary aneurysms associated with hypereosinophilic syndrome. It presents an interesting case of epinephrine abuse and the unfortunate sequelae. This case illustrates novel approaches in emergency repair of internal iliac artery aneurysm rupture and the management of visceral artery aneurysms and exemplifies how multiple endovascular technologies can be utilized even in the high-risk polymorbid patient.

  19. Angiographic and Clinical Result of Endovascular Treatment in Paraclinoid Aneurysms

    PubMed Central

    Kwon, Wi Hyun; Kim, Sung Tae; Seo, Jung Hwa

    2014-01-01

    Purpose The purpose of this study was to analyze the results of an immediate and mid-term angiographic and clinical follow-up of endovascular treatment for paraclinoid aneurysms. Materials and Methods From January 2002 to December 2012, a total of 113 consecutive patients (mean age: 56.2 years) with 116 paraclinoid saccular aneurysms (ruptured or unruptured) were treated with endovascular coiling procedures. Clinical and angiographic outcomes were retrospectively evaluated. Results Ninety-three patients (82.3%) were female. The mean size of the aneurysm was 5.5 mm, and 101 aneurysms (87.1%) had a wide neck. Immediate catheter angiography showed complete occlusion in 40 aneurysms (34.5%), remnant sac in 51 (43.9%), and remnant neck in 25 (21.6%). Follow-up angiographic studies were performed on 80 aneurysms (69%) at a mean period of 20.4 months. Compared with immediate angiographic results, follow-up angiograms showed no change in 38 aneurysms, improvement in 37 (Fig. 2), and recanalization in 5. There were 6 procedure-related complications (5.2%), with permanent morbidity in one patient. Conclusion Out study suggests that properly selected patients with paraclinoid aneurysms can be successfully treated by endovascular means. PMID:25426303

  20. Endovascular treatment of pediatric intracranial aneurysms: a retrospective study of 35 aneurysms.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Golshan, Ali; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2014-07-01

    Pediatric intracranial aneurysms are rare and not well characterized in comparison with those in adults. To analyze our institution's longitudinal experience of endovascular treatment for pediatric aneurysms to better understand this rare condition. A retrospective record review was performed of patients aged <20 years treated with endovascular methods for intracranial aneurysms between 1995 and 2012. There were 31 patients (average 14.4±4.2 years; 20 male, 11 female) with 35 intracranial aneurysms. The rate of subarachnoid hemorrhage as the initial presentation was 48% and the rates of multiple and giant aneurysms were 13% and 31%, respectively; 28.5% of the cases were posterior circulation aneurysms. Fifteen saccular aneurysms occurred in 14 patients and 17 fusiform aneurysms were noted in 14 patients. Two infectious aneurysms were diagnosed in two patients and one traumatic aneurysm occurred in another patient. Thirty-four aneurysms were treated endovascularly and one had thrombosed spontaneously on a follow-up angiogram. Of the 15 saccular aneurysms, 11 were treated with conventional coiling, one was treated with stent-assisted coiling, one was treated with a flow-diverting stent and two were treated with parent vessel occlusion (PVO). Of the 17 fusiform aneurysms, 15 were treated with PVO with or without prior bypass surgery and one was treated with a flow-diverting stent. The rate of permanent complications and a favorable outcome were 2.9% and 87%, respectively. Endovascular treatment of pediatric aneurysms is technically feasible with an acceptable complication rate despite the high incidence of fusiform aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. A New Murine Model of Endovascular Aortic Aneurysm Repair

    PubMed Central

    Rouer, Martin; Meilhac, Olivier; Delbosc, Sandrine; Louedec, Liliane; Pavon-Djavid, Graciela; Cross, Jane; Legagneux, Josette; Bouilliant-Linet, Maxime; Michel, Jean-Baptiste; Alsac, Jean-Marc

    2013-01-01

    Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis. PMID:23851958

  2. Endovascular treatment of true and false aneurysms in hemodialysis access.

    PubMed

    Hedin, U; Engström, J; Roy, J

    2015-08-01

    Formation of true and false aneurysms in vascular access for hemodialysis is a complication associated with an immediate or chronic threat to the patient, which jeopardizes access function for further dialysis. Although open surgical repair remains the established treatment of choice, during the last decade, endovascular procedures, largely utilizing stent grafts, have emerged as a viable option for treatment in emergencies as well as for elective cases. Here, basic concepts in vascular access aneurysm management are recapitulated and strategies for endovascular treatment of these complications discussed.

  3. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    NASA Astrophysics Data System (ADS)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  4. Design and biocompatibility of endovascular aneurysm filling devices

    PubMed Central

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J.

    2014-01-01

    The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing. PMID:25044644

  5. Endovascular management of visceral artery aneurysms: When to watch, when to intervene?

    PubMed

    Loffroy, Romaric; Favelier, Sylvain; Pottecher, Pierre; Genson, Pierre-Yves; Estivalet, Louis; Gehin, Sophie; Cercueil, Jean-Pierre; Krausé, Denis

    2015-07-28

    Visceral artery aneurysms (VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms (VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the first-line therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.

  6. Endovascular Treatment of Ruptured Anterior Communicating Artery Aneurysms

    PubMed Central

    Nakai, Y.; Sonobe, M.; Kato, N.; Okamoto, S.; Nakamura, K.; Sugita, K.

    2006-01-01

    Summary The aim of this paper is to provide a review of our experience in using the endovascular treatment of ruptured anterior communicating artery (ACoA) aneurysms. Between March 1997 and May 2004, 211 ruptured aneurysms were treated with Guglielmi detachable coil (GDC) system in Mito Medical Center, 73 were located at the ACoA. Two cases were incomplete embolization, and performed microsurgical clipping. In the initial embolization for the 71 aneurysms, complete occlusion was achieved in 44 aneurysms, neck remnant in 11 aneurysms and body filling in 16 aneurysms. Intra-operative complication was occurred in six cases (8.2%). Aneurysm perforation was occurred in three cases (4.1%), thromboembolic complication was occurred in three cases (4.1%). Acute rebleeding were observed in two cases (2.7%). Endovascular treatment is an effective technique for treating ACoA aneurysms, and 3D-rotational angiography is important diagnostic tool for evaluating the ACoA complex. PMID:20569604

  7. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

    PubMed Central

    Orrapin, Saritphat; Arworn, Supapong; Reanpang, Termpong

    2016-01-01

    We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity. PMID:27703834

  8. Aneurysm rupture from blunt abdominal trauma after endovascular repair.

    PubMed

    Bahar, Ilknur G; Tutun, Ufuk; Iscan, Zafer; Ayabakan, Nurcan; Ozdemir, Mustafa

    2016-12-01

    We present a case of aneurysm rupture from severe blunt abdominal trauma due to fight in a patient who had endovascular aneurysm repair. The patient presented to the emergency service with computed tomography evidence of an endoleak and a large retroperitoneal hematoma. The contrast abdominal computed tomography demonstrated a type Ib endoleak, increase in the aneurysm diameter and hematoma in the retroperitoneum. The patient has been taken under interventional procedure for endovascular aneurysm repair revision under urgent condition. Type Ib endoleak was treated by placement of a covered iliac extension limb, but a second leakage from graft body was found in control computed tomography images and open surgical conversion was necessary. Operative findings included a type III endoleak from graft body, defect on fabric. It was seen that the aneurysm sac anterior and posterior parts were ruptured. Upon reviewing the literature, we found that it was an interesting case as the first rupture case which had been developed after severe blunt abdominal trauma during the follow-up period of a patient on which endovascular aneurysm repair procedure had been performed and progressed in this manner. © The Author(s) 2016.

  9. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    PubMed Central

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  10. Endovascular Management of Delayed Complete Graft Thrombosis After Endovascular Aneurysm Repair

    SciTech Connect

    Thurley, Peter D.; Glasby, Michael J.; Pollock, John G.; Bungay, Peter; Nunzio, Mario De; El-Tahir, Amin M.; Quarmby, John W.

    2010-08-15

    Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.

  11. Emergency Endovascular Treatment of Sac Rupture for Type IIIa Endoleak in Thoracic Aortic Aneurysm Previously Excluded with Endovascular Repair

    SciTech Connect

    Carrafiello, Gianpaolo Mangini, Monica Bracchi, Elena Recaldini, Chiara; Cocozza, Eugenio; Piffaretti, Gabriele; Pellegrino, Carlo Lagana, Domenico Fugazzola, Carlo

    2010-08-15

    Elective endovascular treatment of thoracic aortic pathology has been applied in a variety of conditions. The complications of thoracic aortic stenting are also well recognized. Endoleak after endovascular repair of thoracic aortic aneurysms is the most frequent complication; among them, type III is the least frequent. Endovascular treatment of type III endoleak is generally performed under elective conditions; less frequently, in emergency. We report a successful emergency endovascular management of post-thoracic endovascular repair for thoracic aortic aneurysm rupture due to type IIIa endoleak.

  12. [Percutaneous treatment of a superficial femoral artery aneurysm using an intravascular stent-prosthesis].

    PubMed

    Michel, C; Laffy, P Y; Leblanc, G; Riou, J Y; Chaloum, S; Maklouf, M; Le Guen, O

    1999-05-01

    One case of superficial femoral aneurysm treated percutaneously by endovascular stent graft (Passager Boston) is reported. The initial radiographic evaluation included arteriography and color doppler sonography which enable analysis of the flow path, the extent of the wall thrombus, the choice of stended graft size. The procedure of implantation was technically trouble free. The post-procedure 3D CT and arteriography demonstrated occlusion of the aneurysm and resaturation of normal flow path. The six and twelve month check confirmed the stability of the results locally and the integrity of run off vessels. In weakened and specially elderly patient percutaneous treatment of superficial femoral artery aneurysm can be carried out easily. The contribution of 3D CT is essential in follow up to ensure an optimal result and to detect any complication.

  13. A Propensity Score-Matched Analysis of Inflammatory Response With Endovascular Aneurysm Sealing vs Endovascular Aneurysm Repair.

    PubMed

    Berg, Patrick; Stroetges, Roland A; Miller, Larry E; Schoefferle, Jochen

    2017-10-01

    To evaluate the risk of postimplantation syndrome associated with endovascular aneurysm sealing (EVAS) and endovascular aneurysm repair (EVAR) in patients treated for abdominal aortic aneurysm (AAA). From December 2013 to May 2015, 41 AAA patients treated with EVAS (mean age 72±9 years; 38 men) and 63 with EVAR (mean age 74±10 years; 55 men) at a single center were retrospectively reviewed. To control for treatment selection bias, propensity score matching was used to compare outcomes by treatment mode. Main outcomes were postimplantation syndrome (defined as temperature >38°C and leukocyte count >12,000/µL), inflammatory response markers [platelets and high-sensitivity C-reactive protein (hs-CRP)], and clinical complications through 30 days. In 39 matched patients per group, the incidences of postimplantation syndrome (p=0.07), mean body temperature (p=0.05), mean leukocyte count (p=0.003), and mean hs-CRP (p<0.001) were proportionally lower with EVAS vs EVAR. Serious adverse events (0% vs 12.8%, p=0.05) and endoleaks (0% vs 10.3%, p=0.13) through 30 days were less frequent with EVAS, but the group differences were not significantly different. The choice of endovascular graft material influenced postoperative and 30-day clinical outcomes, with greater overall risk observed with polyester stent-grafts. Endovascular aneurysm sealing is associated with a blunted systematic inflammatory response compared with EVAR. Polyester stent-grafts induce the greatest periprocedural inflammatory response.

  14. Management of Splenic Artery Aneurysms and False Aneurysms with Endovascular Treatment in 12 Patients

    SciTech Connect

    Guillon, R.; Garcier, J.M.; Abergel, A.; Mofid, R.; Garcia, V.; Chahid, T.; Ravel, A.; Pezet, D.; Boyer, L.

    2003-06-15

    Purpose: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. Methods: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n = 10) or false aneurysm (n = 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six,and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months;in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. Results: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-upon CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. Conclusion: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

  15. Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

    PubMed Central

    Yatomi, Kenji; Oishi, Hidenori; Yamamoto, Munetaka; Suga, Yasuo; Nonaka, Senshu; Yoshida, Kensaku; Arai, Hajime

    2014-01-01

    Summary Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly. PMID:25496693

  16. Endovascular Treatment of Cerebral Aneurysm with Coils and Onyx

    PubMed Central

    Ueno, J.; Tohma, N.

    2004-01-01

    Summary We investigated endovascular treatment of cerebral aneurysm by coil and Onyx in vivo experiment in order to promote the advantages of coil embolization,. The aim of this study was to clarify the advantages and problems of coil and Onyx embolization and to evaluate its potentials for application in clinical medicine. We set experimental aneurysms made of external jugular vein to bilateral carotid arteries of 10 Beagle dogs and embolized aneurysm with coils and Onyx. Two months later, the dogs were sacrificed and took out the experimental aneurysms and examined them histologically. We have experienced Onyx migration into the vessel at the beginning of our experiment. Technical problems were as follows; Onyx was not easily visible on DSA monitor particularly in tight coil packing. Catheter tip was often stuck to the Onyx in the aneurysm. Protect balloon could not completely protect the Onyx leakage into the vessel. Microscopic examinations were as follows; The aneurysm was filled with Onyx, coils, and inflammatory reactants. The orifice of the aneurysm was packed with augmented fibrous tissue. 1. This method increased contact between the aneurysm wall and coils. 2. Onyx filled the intra-aneurismal space more tightly. 3. Coils prevented Onyx from flowing out into the vessel. 4. In Onyx, intimal layer was more rapidly formed at the neck of the aneurysm than coils only. 5. The most important problems during Onyx embolization is how to prevent Onyx migration into the vessel. We should like to propose the guideline for Onyx embolization. PMID:20587272

  17. Aortoiliac elongation after endovascular aortic aneurysm repair.

    PubMed

    Chandra, Venita; Rouer, Martin; Garg, Trit; Fleischmann, Dominik; Mell, Matthew

    2015-07-01

    Aortoiliac elongation after endovascular aortic aneurysm repair (EVAR) is not well studied. We sought to assess the long-term morphologic changes after EVAR and identify potentially modifiable factors associated with such a change. An institutional review board-approved retrospective review was conducted for 88 consecutive patients who underwent EVAR at a single academic center from 2003 to 2007 and who also had at least 2 follow-up computed tomography angiograms (CTAs) available for review up to 5 years after surgery. Standardized centerline aortic lengths and diameters were obtained on Aquarius iNtuition 3D workstation (TeraRecon Inc., San Mateo, CA) on postoperative and all-available follow-up CTAs. Relationships to aortic elongation were determined using Wilcoxon rank-sum test or linear regression (Stata version 12.1, College Station, TX). Changes in length over time were determined by mixed-effects analysis (SAS version 9.3, Cary, NC). The study cohort was composed of mostly men (88%), with a mean age of (76 ± 8) and a mean follow-up of 3.2 years (range, 0.4-7.5 years). Fifty-seven percent of patients (n = 50) had devices with suprarenal fixation and 43% (n = 38) had no suprarenal fixation. Significant lengthening was observed over the study period in the aortoiliac segments, but not in the iliofemoral segments. Aortoiliac elongation over time was not associated with sex (P = 0.3), hypertension (P = 0.7), coronary artery disease (P = 0.3), diabetes (P = 0.3), or tobacco use (P = 0.4), but was associated with the use of statins (P = 0.03) and the presence of chronic obstructive pulmonary disease (P = 0.02). Significant aortic lengthening was associated with increased type I endoleaks (P = 0.03) and reinterventions (P = 0.03). Over the study period, 4 different devices were used; Zenith (Cook Medical Inc., Bloomington, IN), Talent (Medtronic, Minneapolis, MN), Aneuryx (Medtronic), and Excluder (W. L. Gore and Associates Inc., Flagstaff, AZ). After adjusting for

  18. Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

    PubMed Central

    Han, Jinsol; Ha, Sung-Kon; Choi, Jong-Il; Jin, Sung-Won; Kim, Se-Hoon

    2016-01-01

    Objective Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. Materials and Methods Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. Results Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. Conclusion Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment. PMID:27847762

  19. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

    SciTech Connect

    Pitton, Michael B. Scheschkowski, Tobias; Ring, Markus; Herber, Sascha; Oberholzer, Katja; Leicher-Dueber, Annegret; Neufang, Achim; Schmiedt, Walther; Dueber, Christoph

    2009-09-15

    The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 {+-} 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 {+-} 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 {+-} 4.7 months. Mean survival and freedom from any event was 66.7 {+-} 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P < 0.01). Patients in whom all aneurysm side branches were occluded prior to stent-grafting showed a significantly reduced incidence of large endoleaks. Endoleaks >10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks ({Delta} at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular

  20. Aortic Arch Aneurysms: Treatment with Extra anatomical Bypass and Endovascular Stent-Grafting

    SciTech Connect

    Kato, Noriyuki; Shimono, Takatsugu; Hirano, Tadanori; Mizumoto, Toru; Ishida, Masaki; Fujii, Hideki; Yada, Isao; Takeda, Kan

    2002-10-15

    Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However,patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extra anatomical bypass surgery and endovascular stent-grafting.

  1. The Use of Direct Thrombin Injection to Treat a Type II Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysm

    SciTech Connect

    Ellis, Peter K. Kennedy, Peter T.; Collins, Anton J.; Blair, Paul H.

    2003-09-15

    This report describes the use of thrombin to treat a type II endoleak which was causing continued abdominal aortic aneurysm expansion in a patient who had undergone endovascular repair. A small quantity of thrombin was injected into the leak by a percutaneous approach directly into the aneurysm sac using color doppler ultrasound. The procedure was successful and required only a few minutes to perform. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

  2. Selection of Endovascular Approach of Vein of Galen Aneurysmal Malformation

    PubMed Central

    Ito, O.; Goto, K.; Ogata, N.; Utsunomiya, H.; Sato, S.; Fukumura, A.

    2001-01-01

    Summary Vein of Galen aneurysmal malformation (VGAM) is one of the most difficult intracranial vascular lesions because this disease consists of extremely high flow shunts and affects infants and small children. Thanks to the development of various diagnostic modalities, early diagnosis became possible allowing us to prepare appropriately according to the patients' general and neurological conditions. Recent improvements of endovascular techniques and materials enabled both transarterial and transvenous approaches even to the newborn infants, widening therapeutic windows. In this article, we discuss the selection of endovascular approaches based upon angioarchitecture of VGAM presenting four representative cases from our file. PMID:20663400

  3. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

    PubMed Central

    Kothandan, Harikrishnan; Haw Chieh, Geoffrey Liew; Khan, Shariq Ali; Karthekeyan, Ranjith Baskar; Sharad, Shah Shitalkumar

    2016-01-01

    Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA) and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co-morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well-tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR. PMID:26750684

  4. Percutaneous Ablation of an Internal Iliac Aneurysm Using Tissue Adhesive

    SciTech Connect

    Owen, Richard J.T.; Jackson, Ralph; Loose, Henry W.; Lees, Timothy A.; Dunlop, Paul; Rose, John D.G.

    2000-09-15

    We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.

  5. A 2-Stage Surgical and Endovascular Treatment of Rare Multiple Aneurysms of Pancreatic Arteries.

    PubMed

    Aryal, Bibek; Komokata, Teruo; Ueno, Takayuki; Yamamoto, Bunsei; Senokuchi, Terutoshi; Yasuda, Hiroshi; Kaieda, Mamoru; Imoto, Yutaka

    2017-04-01

    Aneurysms of pancreatic arteries (PAs) are often found incidentally during evaluation of other abdominal pathology. Aneurysms involving multiple PAs are rarely reported in the literature. In case reports of PA aneurysm, inferior pancreaticoduodenal artery is the usual site of aneurysm occurrence. PA aneurysms can be treated surgically by aneurysm exclusion, excision, and by endovascular techniques. However, no clear consensus exists regarding treatment modality, leaving the surgeon to determine the most appropriate approach bearing in mind their experience, anatomical location of the aneurysm, involved artery, and urgency of the procedure. We report a rare PA aneurysm involving dorsal pancreatic artery (DPA) and anterior inferior pancreaticoduodenal artery (AIPDA) associated with celiac stenosis that was incidentally diagnosed in a patient with hepatic hemangioma. In addition, we reviewed data from the literature on patients with diffuse or multiple PA aneurysms and discuss the treatment modality in these rare variants. Both surgical and endovascular procedures are equally advocated in treatment of multiple PA aneurysms. In our report, we demonstrate a 2-stage surgical and endovascular treatment modality; DPA aneurysm that was not suitable for endovascular treatment was surgically resected and an iliohepatic bypass was made between left common iliac artery and AIPDA to ensure good hepatic perfusion. One month after the first procedure, AIPDA aneurysm was treated with endovascular embolization. Two-stage surgical and endovascular procedure may represent a useful strategy to treat aneurysms involving multiple PAs. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Endovascular Stenting of Peripheral Infected Aneurysms: A Temporary Measure or a Definitive Solution in High-Risk Patients

    SciTech Connect

    Riga, Celia; Bicknell, Colin; Jindal, Ravul; Cheshire, Nicholas; Hamady, Mohamad

    2008-11-15

    The purpose of this study was to demonstrate the use of endovascular technology in the management of peripheral infected aneurysms in high-risk patients as a temporary measure or definitive solution. Five cases underwent successful endovascular stenting of infected aneurysms of the subclavian, femoral, and carotid arteries. All these patients were at high risk for open surgery. Covered stents were placed by percutaneous approach under local anesthesia in all patients. Postoperatively, antibiotics were continued for 3 months. A literature review using the Medline database was also undertaken, and all the relevant papers on endovascular management of peripheral infected aneurysms were taken into account. Stent deployment was successful in all patients. One patient died of mediastinal sepsis and another from type A aortic dissection 5 weeks later. Two patients required drainage of the infected hematoma. Three patients did well at a median follow-up of 1 year, with no evidence of sepsis. A review of the literature shows promising early and midterm results. Most early reports were of single cases, reflecting the low incidence of peripheral infected aneurysms. We conclude that further development of endoluminal techniques and long-term follow-up to establish the durability of stenting could potentially lead to a decrease in the high morbidity and mortality rates associated with infected aneurysmal disease in this high-risk group of patients.

  7. The role of endovascular treatment in unruptured basilar tip aneurysms.

    PubMed

    Ge, Huijian; Lv, Xianli; Jin, Hengwei; Tian, Zhihua; Li, Youxiang; He, Hongwei

    2017-02-01

    Objective This study was to evaluate the safety and efficiency of endovascular treatment of unruptured basilar tip aneurysms. Methods We retrospectively reviewed consecutive 79 cases of unruptured basilar tip aneurysms in our center between 2009 and 2014. The patients' clinical and imaging information were recorded. Complications, initial occlusion rate, clinical outcomes and the predictors were retrospectively analyzed. Results Thirty-five cases received conservative treatment and 44 cases were treated by endovascular embolization. In the conservative treatment group, six (19.4%) of 31 basilar tip aneurysms ruptured and resulted in five deaths (16.1%) during the mean 18.1-month follow-up (range from 1 to 60 months). Among the endovascularly treated cases, 24 (54.5%) achieved initial complete occlusion and no delayed hemorrhagic events occurred during the mean 33.6-month follow-up (range from 10 to 68 months). For 20 (45.5%) incompletely occluded cases, five postoperative or delayed hemorrhagic events and two mass effect events resulted in six deaths. There were no statistical significant differences in hemorrhagic events ( p = 0.732) and mortality ( p = 0.502) between the incomplete occlusion group and untreated group. Large aneurysm size (≥10 mm) was an independent predictor for incomplete occlusion ( p = 0.002), which had a potential risk of postoperative or delayed hemorrhage. On univariate analysis, initial occlusion rate and aneurysm size were found to be associated with clinical outcomes ( p = 0.042 and 0.015). Conclusion Complete occlusion for unruptured basilar tip aneurysm proved to be a safe and effective therapeutic method that could eliminate the potential risk of postoperative or delayed hemorrhage.

  8. Custom Fenestration Templates for Endovascular Repair of Juxtarenal Aortic Aneurysms

    PubMed Central

    Leotta, Daniel F.; Starnes, Benjamin W.

    2015-01-01

    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from CT images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a 3D printer to create a clear rigid sleeve that replicates the patient’s aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after removing the sleeve. Custom fenestration templates can potentially save procedural costs and make minimally-invasive aortic aneurysm repair available to more patients. PMID:25864045

  9. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms.

    PubMed

    Leotta, Daniel F; Starnes, Benjamin W

    2015-06-01

    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from computed tomography images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a three-dimensional printer to create a clear rigid sleeve that replicates the patient's aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after the sleeve is removed. Custom fenestration templates can potentially save procedural costs and make minimally invasive aortic aneurysm repair available to more patients.

  10. Nellix EndoVascular Aneurysm Sealing System: Device description, technique of implantation, and literature review.

    PubMed

    Batagini, Nayara Cioffi; Hardy, David; Clair, Daniel G; Kirksey, Lee

    2016-03-01

    Clinical outcome reports document that from 30% to 60% of endovascular aneurysm repair procedures are performed outside of US Food and Drug Administration-approved Instruction for Use, or "off label." Endovascular aneurysm repair performed outside of Instruction for Use has a significantly higher rate of device failure, potentially requiring device reintervention and even planned or emergent explant. The Nellix device has the potential to reduce the rate of aneurysm device failure through its novel design. The objective of this article was to introduce the Nellix EndoVascular Aneurysm Sealing System and indications for use and describe the technique of implantation. We describe various modes of endovascular aneurysm repair failure and how the Nellix system can reduce these unplanned adverse outcomes. Additional clinical applications and theoretical shortcomings of endovascular aneurysm sealing devices are detailed. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The management of vertebrobasilar dissecting aneurysm using endovascular embolization.

    PubMed

    Chen, Lizhao; Xu, Lunshan; Yang, Donghong; Zou, Yongwen; Xu, Minhui

    2014-09-01

    To explore the imaging features of the vertebrobasilar artery dissecting aneurysm (VBA-DA) and to evaluate the effect of endovascular treatments. Five patients with VBA-DA undergoing endovascular treatments were retrospectively studied. Stent-alone technique was used to treat two of the patients, stent-assisted coil embolization of aneurysm in one patient, coil embolization of parent artery in the other patient, and stent-assisted coil embolization of parent artery in the last patient. Postoperative angiography revealed complete occlusion of aneurysm in two patients and delayed image development in three patients. One patient suffered postoperative cerebral hemorrhage without any neurological deficits. Five patients achieved favorable outcomes on both the imaging results and clinical recovery during a mean follow-up of 20.2 months (range 6-90 months). The string sign pearl and string sign and double-lumen sign are typical imaging features of VBA-DA. Treatment modality is determined by the imaging results. Endovascular embolization is a minimally-invasive, safe, effective, and reliable intervention for managing VBA-DA.

  12. Endovascular abdominal aortic aneurysm repair in the geriatric population

    PubMed Central

    Saratzis, Athanasios; Mohamed, Saif

    2012-01-01

    Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date. PMID:23097659

  13. Results of Endovascular Management for Mid-Basilar Artery Aneurysms

    PubMed Central

    Zhang, J.; Zhang, R.; Wu, Z.; Lv, X.; Liu, B.

    2010-01-01

    We evaluated the results of endovascular management of patients with mid-basilar artery aneurysm (mBAA). During a seven year period, 14 patients (mean age 39.6 years, male/female ratio 1:1) with mBAA were treated with endovascular techniques at our institute. Pretreatment clinical grades were determined using the Hunt-Hess scale. Outcome was evaluated using the Glasgow Outcome Scale scores (GOS) during a mean follow-up period of 15.6 months (range, three to 70 months). Fourteen patients with 15 mBAAs were treated endovascularly. Four (28.6%) patients died of rebleeding within one day after embolization. In ten mBAAs, immediate postprocedural angiograms showed that complete occlusion was achieved, subtotal occlusion in one, and incomplete occlusion in four. Follow-up angiographic results in ten patients confirmed complete occlusion of 11 aneurysms. Long-term outcome was good (GOS Score 4 or 5) in ten patients (71.4%) and fatal (GOS Score 1) in four (28.6%). Favorable overall long-term outcome can be achieved in 78.6% patients with mBAAs. Endovascular management of mBAAs is an effective treatment in the long-term. In our experience, the natural history of mBAAs is dismal. PMID:20977855

  14. Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

    PubMed Central

    Wan, Jun; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying; Lu, Gang; Huang, Lei; Zhang, Lei; Ge, Liang; Ji, Lihua

    2014-01-01

    Background Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown. We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment. Material/Methods We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patients underwent ECE of aneurysm neck for 86 RICABF. Treatments outcomes included secondary rupture/bleeding rate, aneurysm neck embolization rate, residual/recurrent aneurysm, intraoperative incidents, and post-embolization complications, as well as improvements in the Glasgow outcome scale (extended) (GOS-E). Results Complete occlusion was achieved in 72 aneurysms (72/86, 83.7%), while 12 aneurysms (12/86, 14.0%) had a residual neck, and 2 aneurysms (2/86, 2.3%) had a residual aneurysm. The postoperative GOS-E was 3 in 3 patients (3.5%), 4 in 10 patients (11.6%), and 5 in 73 patients (84.9%). Follow-up angiography was performed in all patients (mean 9.0 months, interquartile range of 9.0). Recurrence was found in 3 patients (3/86, 3.5%). No aneurysm rupture or bleeding was reported. Conclusions Our mid-term follow-up study showed that ECE of aneurysm neck was an effective and safe treatment modality for RICABF. The long-term effectiveness and safety of this interventional radiology technique need to be investigated in prospective and comparative studies. PMID:24986761

  15. Design and biocompatibility of endovascular aneurysm filling devices

    SciTech Connect

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; Landsman, Todd L.; Boyle, Anthony; Wierzbicki, Mark A.; Hasan, Sayyeda M.; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J.

    2014-08-04

    We report that the rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. Lastly, we also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.

  16. Design and biocompatibility of endovascular aneurysm filling devices

    DOE PAGES

    Rodriguez, Jennifer N.; Hwang, Wonjun; Horn, John; ...

    2014-08-04

    We report that the rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several suchmore » devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. Lastly, we also present novel polymeric based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.« less

  17. Design and biocompatibility of endovascular aneurysm filling devices.

    PubMed

    Rodriguez, Jennifer N; Hwang, Wonjun; Horn, John; Landsman, Todd L; Boyle, Anthony; Wierzbicki, Mark A; Hasan, Sayyeda M; Follmer, Douglas; Bryant, Jesse; Small, Ward; Maitland, Duncan J

    2015-04-01

    The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric-based aneurysm filling methods that are currently being tested in animal models that could result in superior healing. © 2014 Wiley Periodicals, Inc.

  18. Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

    SciTech Connect

    Jenssen, Guttorm L. Wirsching, Jan; Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin

    2007-06-15

    Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

  19. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  20. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

    SciTech Connect

    Lagana, Domenico Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Caronno, Roberto; Castelli, Patrizio; Cuffari, Salvatore; Fugazzola, Carlo

    2006-04-15

    Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

  1. Stent graft types for endovascular repair of abdominal aortic aneurysms.

    PubMed

    Duffy, James M N; Rolph, Rachel; Waltham, Matthew

    2015-09-24

    The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. This is an update of the review first published in 2013. This review aimed to assess the different stent graft types for endovascular repair of AAA. The Cochrane Vascular Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2015) and the Cochrane Register of Studies (2015, Issue 1). Trial databases were searched by the TSC for details of ongoing and unpublished studies. All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of AAAs were sought without language restriction and in consultation with the Cochrane Vascular Group TSC. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. No studies were identified that met the inclusion criteria. It was not possible to review the quality of the evidence in the absence of studies eligible for inclusion in the review. Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.

  2. Surveillance Imaging Following Endovascular Aneurysm Repair

    PubMed Central

    Pandey, Nirnimesh; Litt, Harold I.

    2015-01-01

    There is a significant risk of complication following endovascular abdominal repair (EVAR), including endoleak, graft translocation, thrombosis, and infection. Surveillance imaging is important for detecting EVAR complication. Surveillance modalities include conventional X-ray, computed tomography, magnetic resonance imaging, ultrasound, and conventional angiography, with inherent advantages and drawbacks to each modality. The authors present common complications following EVAR, and recent advances in the key modalities for surveillance. PMID:26327742

  3. Late Recurrence of a Hepatic Artery Aneurysm After Treatment Using an Endovascular Stent

    SciTech Connect

    Downer, Jonathan; Choji, Kiyoshi

    2008-11-15

    Endovascular stent placement and coil embolization have become established options in the treatment of visceral arterial aneurysms. In this article we report the case of an 83-year-old presenting with gastrointestinal hemorrhage due to a recurrent hepatic arterial aneurysm occurring 12 years after treatment with an endovascular stent. The recurrent aneurysm had resulted from stent fracture and was successfully treated by coil embolization. To our knowledge, stent fracture complicating the endovascular treatment of a visceral artery aneurysm has not been described in the published literature. With the increasing use of metallic endoprostheses in interventional radiology, recognizing and reporting device failure are of critical importance.

  4. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    PubMed

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  5. Endovascular Aneurysm Sealing for the Treatment of Ruptured Abdominal Aortic Aneurysms

    PubMed Central

    Brownrigg, Jack R. W.; Karthikesalingam, Alan; Patterson, Benjamin O.; Holt, Peter J. E.; Hinchliffe, Robert J.; Morgan, Robert A.; Loftus, Ian M.; Thompson, Matthew M.

    2015-01-01

    Purpose: To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing. Case Report: Between December 2013 and April 2014, 5 patients (median age 71 years, range 57–90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67–91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0–3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months). Conclusion: EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology. PMID:25904491

  6. [Successful endovascular treatment of thoracic aortic aneurysm secondary to infection of the umbilical artery catheter in preterm infants].

    PubMed

    Borchert, Evelyn; Lema, Guillermo; Springmuller, Daniel; González, Katia; Chang, Win T; González, Rodrigo; Garay, Francisco

    2015-01-01

    Aortic aneurysms (AA) in the paediatric population are uncommon. The use of umbilical catheters in neonates has been associated with infections and, on some occasions, the formation of aortic aneurysms. The surgical repair of these aneurysms is one type of treatment; however, percutaneous intervention with stents could provide an alternative treatment route, with fewer complications. The aim of this report is to present the therapeutic scope of a hybrid procedure, in which the combined surgical and percutaneous technique offers a less invasive alternative to open surgery for the repair of aortic aneurysms or their main branches. The case concerns a pre-term newborn of 30 weeks weighing 1,335 g. An umbilical catheter was introduced, which was withdrawn at 14 days due to an infection. It developed as Staphylococcus aureus with sepsis. The echocardiogram and Angio-CT confirmed AA, which were managed using a hybrid procedure of surgery and the endovascular implantation of 2 coated stents (Atrium V12 XR Medical Corp, Hudson, NH). The post-procedure clinical follow-ups, including abdominal echo-tomography, confirmed the success of the treatment. The endovascular aortic aneurysm repair procedure in premature newborns may be considered when deciding treatment of this disease, and could avoid the risks associated with open surgery. However, follow-up and monitoring is required while the patient grows up, due to the possibility that the implanted stents require re-dilating. The outcomes of neonatal endovascular procedures in the future are unknown. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Transradial approach to treating endovascular cerebral aneurysms: Case series and technical note

    PubMed Central

    Goland, Javier; Doroszuk, Gustavo Fabián; Garbugino, Silvia Lina; Ypa, María Paula

    2017-01-01

    Background: Several benefits have been described over the years of the transradial versus femoral endovascular approach to cardiac interventions. Consequently, its use has become habitual at most centers that perform cardiac catheterizations. This paper details a right transradial approach, incorporating a variety of coils or flow diverters, which can be utilized for the endovascular treatment of different cerebral aneurysms. Methods: From 2014 to 2016, we performed 40 endovascular procedures to treat cerebral aneurysms adopting the same right transradial approach. Five aneurysms were treated with flow diverters and 35 were treated with coils. Seven of these aneurisms were asymptomatic, whereas 33 had already ruptured. Results: Satisfactory treatment was achieved in all cases through the same approach in the absence of any complications. Conclusions: A right transradial approach may be satisfactory for the endovascular treatment of different cerebral aneurysms, including aneurysms in either hemisphere. This is the largest series of cerebral aneurysms treated through a transradial approach. PMID:28584676

  8. Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

    PubMed Central

    Ahn, Su Yeon; Choi, Young Ho; Jung, In Mok; Chung, Jung Kee

    2015-01-01

    Objective To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. Materials and Methods Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. Results The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. Conclusion Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment. PMID:25741197

  9. Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques.

    PubMed

    Ashour, Ramsey; Dodson, Stephen; Aziz-Sultan, M Ali

    2016-01-01

    Intracranial blister aneurysms are rare lesions that are notoriously more difficult to treat than typical saccular aneurysms. High complication rates associated with surgery have sparked considerable interest in endovascular techniques, though not well-studied, to treat blister aneurysms. To evaluate our experience using various endovascular approaches to treat blister aneurysms. All consecutive blister aneurysms treated using an endovascular approach by the study authors over a 3-year period were retrospectively analyzed. A literature review was also performed. Nine patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils in 5/11, and Onyx in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely occluded by endovascular means alone requiring no further treatment and 1/9 aneurysms required surgical bypass/trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, modified Rankin Scale scores were improved in six patients, stable in two, and worsened in one patient. One complication occurred in 11 procedures (9%), resulting in a permanent neurologic deficit. No unintended endovascular parent vessel sacrifice, intraprocedural aneurysmal ruptures, antiplatelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred. This series highlights both the spectrum and limitations of endovascular techniques currently used to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and experience in larger studies are required to better define the role of endovascular therapy in the management of these difficult lesions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Endovascular Treatment of Ruptured Iliac Aneurysm Previously Treated by Endovascular Means

    SciTech Connect

    Dalainas, Ilias Nano, Giovanni; Stegher, Silvia; Bianchi, Paolo; Malacrida, Giovanni; Tealdi, Domenico G.

    2008-03-15

    A patient with a ruptured iliac aneurysm was admitted to the Emergency Department in hypovolemic shock. He had previously undergone surgical treatment for an infrarenal abdominal aortic aneurysm, which was managed with a terminal-terminal Dacron tube graft. Subsequently, he developed two iliac aneurysms, which were treated endovascularly with two wall-grafts in the right and one wall-graft in the left iliac arteries. He suffered chronic renal failure and arterial hypertension. Contrast-enhanced computed tomography showed rupture of the right iliac aneurysm and dislocation of the two wall-grafts. He was treated in an emergency situation with the implantation of an iliac endograft that bridged the two wall-grafts, which resulted in hemostasis and stabilization of his condition. Five days later, in an elective surgical situation, he was treated with the implantation of an aorto-uni-iliac endograft combined with a femoral-femoral bypass. He was discharged 5 days later in good condition. At the 4 year follow-up visit, the endoprosthesis remained in place with no evidence of an endoleak. In conclusion, overlapping of endografts should be avoided, if possible. Strict surveillance of the endovascularly treated patient remains mandatory.

  11. Enhancing brain lesions after endovascular treatment of aneurysms.

    PubMed

    Cruz, J P; Marotta, T; O'Kelly, C; Holtmannspötter, M; Saliou, G; Willinsky, R; Krings, T; Agid, R

    2014-10-01

    Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We present 7 patients from 5 different institutions that developed MR imaging-enhancing brain lesions after endovascular therapy of aneurysms, detected after a median time of 63 days. The number of lesions ranged from 4-46 (median of 10.5), sized 2-20 mm, and were mostly in the same vascular territory used for access. Three patients presented with symptoms attributable to these lesions. After a median follow-up of 21.5 months, the number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1. The imaging and clinical characteristics suggested a foreign body reaction. We could find no correlation to a specific device, but a possible source may be the generic hydrophilic coating.

  12. Endovascular treatment of endoleaks after endovascular abdominal aortic aneurysm repair: personal experience.

    PubMed

    Pozzi Mucelli, F; Doddi, M; Bruni, S; Adovasio, R; Pancrazio, F; Cova, M

    2007-04-01

    This paper describes the different endovascular treatments (cuffs, endografts and embolisation) available for types I, II and III endoleaks occurring after endovascular abdominal aortic aneurysm repair (EVAR). From January 2000 to June 2006, 134 patients (118 men, 16 women; mean age 75.1 years) underwent EVAR. Ten patients (7%) developed significant endoleaks requiring endovascular treatment. Five endoleaks were type I, two were type II and three were type III. Of the five type I endoleaks, four were proximal and one was distal. The proximal endoleaks were treated by cuff deployment, whereas the distal endoleak was treated with a bifurcated graft. Of the two patients with type II endoleak, one was treated by translumbar puncture and coil embolisation, and the other was treated by superselective embolisation of the lumbar feeding vessel with nonresorbable particles. Of the three patients with type III endoleak, two were treated by deploying an aortouniiliac endograft inside the bifurcated graft and the other by implanting a cuff to restore continuity between the graft body and the contralateral limb. Endovascular treatment was successful in 6/10 cases, whereas three cases required surgical conversion. One patient did not undergo surgery owing to poor general condition. The reported incidence of endoleaks after EVAR is 10%-20%. Significant endoleaks should be treated promptly. Endovascular treatment can be done with different techniques, but success in not constant due to adverse anatomical conditions and technical difficulties.

  13. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: Correlation of aneurysm neck size and treatment results

    SciTech Connect

    Zubillaga, A.F.; Guglielmi, G.; Vinuela, F.; Duckwiler, G.R.

    1994-05-01

    To devise a method to measure aneurysm neck size on angiographic films, and to correlate the sizes obtained with the extent of endovascular aneurysm occlusion, performed with electrically detachable coils. The angiograms of 79 intracranial aneurysms treated by endovascular occlusion using electrically detachable coils were retrospectively analyzed. A method using the average reported caliber of the major intracranial vessels was applied to determine the aneurysm neck sizes on the diagnostic angiograms. The cases were divided into two groups according to neck size, 4 mm being the discriminative value for small and wide necks. The posttreatment angiogram of each case was analyzed to evaluate the degree of occlusion achieved by the technique. Necks were successfully measured in 95% of the aneurysms. Complete aneurysm thrombosis was observed in 85% of the small-necked aneurysms and in 15% of the wide-necked aneurysms. Accurate angiographic measurements of neck diameter can be obtained in most aneurysms. The size of an aneurysm neck correlates well with the results of the endovascular treatment. Small-necked aneurysms can be satisfactorily occluded with this technique. In wide-necked aneurysms this technique should be reserved for lesions having a high surgical risk. 10 refs., 1 fig., 1 tab.

  14. Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT.

    PubMed

    Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka

    2009-07-01

    Inflammatory abdominal aortic aneurysm (IAAA) is characterized by inflammatory and/or fibrotic changes in the periaortic regions of the retroperitoneum. Surgical repair is usually selected for this disease. However, the perioperative mortality associated with open surgical repair of IAAs is three times higher than that with noninflammatory aortic aneurysms due to inflammation and periaortic fibrosis (PAF). Endovascular aneurysm repair of IAAs excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of PAF with acceptable peri-interventional and long-term morbidity. We describe the successful endovascular repair of an IAAA and the serial CT findings after repair.

  15. Role of Endovascular Treatment in Pediatric Cerebral Aneurysms: A Series of Two Case Reports

    PubMed Central

    Alurkar, Anand; Karanamm, Lakshmi Sudha Prasanna; Oak, Sagar

    2012-01-01

    Aneurysms in the pediatric age group are rare and have preponderance for the posterior circulation. These aneurysms are more commonly large, giant, and complex. We present two case reports of saccular aneurysms in pediatric patients who were treated successfully by endovascular technique. PMID:23393631

  16. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    SciTech Connect

    Muehlenbruch, Georg Nikoubashman, Omid; Steffen, Bjoern; Dadak, Mete; Palmowski, Moritz; Wiesmann, Martin

    2013-02-15

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  17. Dacron Graft Aneurysm Treated by Endovascular Stent-Graft

    SciTech Connect

    Ofer, Amos; Nitecki, Samy; Hoffman, Aaron; Engel, Ahuva

    2001-01-15

    A 72-year old man who underwent aorto-bifemoral bypass with insertion of a Dacron graft 18 years previously presented with an aneurysm in the left limb of his graft. Angiography also demonstrated a bilateral occlusion of the popliteal arteries. Computed tomography (CT) angiography was performed and showed a localized dilation of 3 cm in the left limb of the graft, which had a diameter of 14 mm throughout. In view of the technical difficulties of a surgical procedure, an endovascular stent was considered. Through a left femoral arteriotomy, a stent graft was inserted and deployed in the left limb of the graft. This resulted in total exclusion of the Dacron graft aneurysm. To the best of our knowledge, this is the first report of such a procedure.

  18. RADIATION EXPOSURE DURING INFRARENAL ENDOVASCULAR AORTIC ANEURYSM REPAIR.

    PubMed

    Ahmed, A; Badawy, A; Chaudhuri, A

    2017-09-01

    Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms exposes patients and healthcare professions to the deterministic and stochastic effects of ionization radiation. The study aim was to determine our standard of radiation exposure in infrarenal EVARs and compare it against other published data and national guidelines. A retrospective analysis of a prospectively collected database of patients undergoing EVARs was obtained. Radiation dose, fluoroscopy time, aneurysm size and patient characteristics were collected. Results are expressed as mean with 95% confidence interval. This study included 147 elective patients undergoing aorto bi-iliac EVAR with a mean age of 76 years from June 2013 until December 2016. The mean dose area product (DAP) was 5.91 (5.07-6.75) mGy.m2, cumulative air kerma (CAK) 248 (211-284) mGy and fluoroscopy time 32.5 (28.5-36.5) minutes. A greater BMI and a longer fluoroscopy time caused a significantly greater DAP to be administered to the patient. The device type, sex, AAA size, smoking status did not significantly effect the DAP administered to the patient. Radiation exposure during endovascular aneurysm repairs is a significant hazard to both the patient and the theatre staff. Our study shows that a greater BMI and total fluoroscopy time can cause greater radiation exposure to patient. Anatomical and technical difficulties are also related to increased radiation exposure. Radiation exposure at our centre is below threshold levels suggested by Stecker et al before radiation induced skin injuries can manifest. Additionally, radiation exposure is comparable to other centres but can be reduced further by reducing our fluoroscopy time and adhering to the principles of ALARA (As low as reasonably achievable).

  19. The association of simple renal cysts with abdominal aortic aneurysms and their impact on renal function after endovascular aneurysm repair.

    PubMed

    Spanos, Konstantinos; Rountas, Christos; Saleptsis, Vasileios; Athanasoulas, Athanasios; Fezoulidis, Ioannis; Giannoukas, Athanasios D

    2016-04-01

    We validated the association of simple renal cysts with abdominal aortic aneurysm and other cardiovascular factors and assessed simple renal cysts' impact on renal function before and after endovascular abdominal aortic aneurysm repair. A retrospective analysis of prospectively collected data was conducted. Computed tomography angiograms of 100 consecutive male patients with abdominal aortic aneurysm who underwent endovascular abdominal aortic aneurysm repair (Group 1) were reviewed and compared with 100 computed tomography angiogram of aged-matched male patients without abdominal aortic aneurysm (Group 2). Patients' demographic data, risk factors, abdominal aortic aneurysm diameter, the presence of simple renal cyst and laboratory tests were recorded. No difference was observed between the two groups in respect to other cardiovascular risk factors except hyperlipidemia with higher prevalence in Group 1 (p < 0.05). Presence of simple renal cysts was independently associated with age (p < 0.05) and abdominal aortic aneurysm (p = 0.0157). There was no correlation between simple renal cysts and abdominal aortic aneurysm size or pre-operative creatinine and urea levels. No difference was observed in post-operative creatinine and urea levels either immediately after endovascular abdominal aortic aneurysm repair or in 12-month follow-up. In male patients, the presence of simple renal cysts is associated with abdominal aortic aneurysm and is increasing with age. However, their presence is neither associated with impaired renal function pre-endovascular abdominal aortic aneurysm repair and post-endovascular abdominal aortic aneurysm repair nor after 12-month follow-up.

  20. National trends for open and endovascular repair of aneurysms in Korea: 2004-2013.

    PubMed

    Joh, Jin Hyun; Park, Yun-Young; Cho, Sung-Shin; Park, Ho-Chul

    2016-11-01

    The introduction of endovascular aneurysm repair has led to a dramatic decline in open aneurysm repair. The aim of this report was to evaluate Korean national trends for the treatment of aneurysms. A serial, cross-sectional study of time trends of patients who underwent aneurysm repair between 2004 and 2013 was conducted. Data from the Health Insurance Review and Assessment Service were used to evaluate the trends of aneurysm repair in the Korean population and to analyze the trends of open and endovascular aneurysm repair among Medicare beneficiaries. A linear-by-linear association was performed to determine alterations in the rates at which these aneurysm repair techniques were performed. A total of 32,130 patients underwent aneurysm repair between 2004 and 2013. The proportion of patients who underwent open repair decreased from 94.0% in 2004 to 54.9% in 2013; whereas the proportion of patients who underwent endovascular repair increased from 6.0% in 2004 to 45.1% in 2013. During the study period, the number of patients undergoing endovascular repair of aortic aneurysms significantly increased from 82 to 1,396 (relative risk, 16.17; 95% confidence interval: 12.94-20.21). Endovascular repair of abdominal aortic aneurysms (AAAs)overtook open repair between 2010 and 2011. The frequency of open aneurysm repair increased 1.2-fold, with an overall downward trend. The prevalence of endovascular repair markedly increased 15.3-fold. These findings indicated that, in Korea, the endovascular repair of AAAs overtook open repair as the most common technique between 2010 and 2011.

  1. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms

    PubMed Central

    Montgomery, Jennifer P.; Kolbeck, Kenneth J.; Kaufman, John A.

    2015-01-01

    Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature. PMID:26327743

  2. Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm with Aortocaval Fistula

    SciTech Connect

    Guzzardi, Giuseppe Fossaceca, Rita; Divenuto, Ignazio; Musiani, Antonello; Brustia, Piero; Carriero, Alessandro

    2010-08-15

    Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA). We report the endovascular repair of an AAA rupture into the inferior vena cava. A 78-year-old woman was admitted to our hospital for acute hypotension. She presented with a pulsatile abdominal mass and became rapidly anuric. Abdominal computed tomography (CT) showed an AAA rupture into the inferior vena cava. The features of the AAA made it suitable for endovascular repair. To prevent pulmonary embolism caused by the presence of sac thrombosis near the vena cava lumen, a temporary vena cava filter was deployed before the procedure. A bifurcated stent-graft was placed with the patient under local anaesthesia, and the AAA was successfully treated. A transient type II endoleak was detected on CT 3 days after endograft placement. At routine follow-up 6 and 12 months after the procedure, the patient was in good clinical condition, and the type II endoleak had sealed completely. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of ACF; however, only small numbers of patients have been treated, and long-term follow-up interval is lacking.

  3. Endovascular Aneurysm Repair with Balloon Thrombectomy for Acute Thrombosis of Abdominal Aortic Aneurysm.

    PubMed

    Uotani, Kensuke; Hamanaka, Akihiro; Matsushiro, Keigo; Idaka, Erika; Ito, Kiyo; Yamasaki, Yuko; Kushima, Takeyuki; Sugimoto, Takaki; Sugimoto, Koji

    2017-08-17

    Acute occlusion of abdominal aortic aneurysm (AAA) is a rare complication and is usually treated with surgical reconstruction. We present a case of acute AAA occlusion that was successfully treated by endovascular aneurysm repair (EVAR) with Fogarty balloon thrombectomy. A 77-year-old man with a history of acute myocardial ischemia presented with limb weakness and coldness. Contrast-enhanced computed tomography showed a 42-mm-diameter infrarenal AAA that was completely thrombosed in the distal portion. The proximal neck of the aneurysm was patent, and its shape was suitable for EVAR. Therefore, we performed balloon thrombectomy of the aortoiliac thrombus that was followed by EVAR. EVAR can be a less invasive alternative than traditional treatment for acute occlusion of AAA.

  4. Extra-anatomic endovascular repair of an abdominal aortic aneurysm with a horseshoe kidney supplied by the aneurysmal aorta.

    PubMed

    Rey, Jorge; Golpanian, Samuel; Yang, Jane K; Moreno, Enrique; Velazquez, Omaida C; Goldstein, Lee J; Chahwala, Veer

    2015-07-01

    Abdominal aortic aneurysm complicated by a horseshoe kidney (HSK, fused kidney) represents a unique challenge for repair. Renal arteries arising from the aneurysmal aorta can further complicate intervention. Reports exist describing the repair of these complex anatomies using fenestrated endografts, hybrid open repairs (debranching), and open aneurysmorrhaphy with preservation of renal circulation. We describe an extra-anatomic, fully endovascular repair of an abdominal aortic aneurysm with a HSK partially supplied by a renal artery arising from the aneurysm. We successfully applied aortouni-iliac endografting, femorofemoral bypass, and retrograde renal artery perfusion via the contralateral femoral artery to exclude the abdominal aortic aneurysm and preserve circulation to the HSK.

  5. Modification of an endovascular stent graft for abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  6. Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient

    SciTech Connect

    Kaskarelis, Ioannis S. Koukoulaki, Maria; Lappas, Ioannis; Karkatzia, Fani; Dimopoulos, Nikitas; Filias, Vasilios; Bellenis, Ion; Vougas, Vasilios; Drakopoulos, Spiros

    2006-04-15

    A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.

  7. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    PubMed

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  8. Endovascular repair of thoracoabdominal aortic aneurysms with a novel multibranch stent-graft design: preliminary experience.

    PubMed

    Kinstner, C; Teufelsbauer, H; Neumayer, C; Domenig, C; Wressnegger, A; Wolf, F; Funovics, M

    2014-08-01

    The aim of this paper was to report our preliminary experience in outcome, safety and mid-term results in the treatment of thoracoabdominal aortic aneurysms (TAAA) with a novel multibranchstentgraft (E-xtra DESIGN ENGINEERING, JOTEC, Germany). Eight patients (mean age 66 years, 2 female) with TAAA (Crawford type I: 2 cases, type III: 3 cases, type IV: 3 cases), mean aneurysm diameter 61 mm, growth over 5 mm per year were treated. Implantation was performed under general anesthesia and surgical exposition of the common femoral artery. Brachial access was percutaneous in 5/8 patients. Balloon-expandable (Advanta V12) bridging stent-grafts were employed and lined with self-expanding nitinol stents. All patients except type IV TAAA received a spinal drainage catheter. The device was successfully deployed in 8/8 patients. 29/32 visceral branches were engaged. One stenosed celiac trunk was left untreated without further consequences, two renal arteries which could not be cannulated were revascularized with iliorenal bypass. One patient needed surgical revision of groin hematoma, one patient suffered from permanent protopathic sensory deficit. No renal complications occurred. Since the primary implantation was deliberately kept short and amount of contrast agent was minimised, four patients needed a secondary percutaneous procedure (Palmaz stent implantation for type I endoleak, re-PTA or additional bridging stent-graft implantation for type III endoleak). The assisted primary success rate was 8/8. Mean follow-up was 18 months. Success was stable in 7/8 patients, one patient shows type V endoleak with 5mm sac expansion. No mortality or complication occurred during follow-up. The JOTEC E-xtra DESIGN ENGINEERING multibranch stent-graft is a promising new candidate for endovascular TAAA treatment with sufficient safety and efficacy. Its short delivery time suggests its use in patients with rapid aneurysm growth or high anxiety.

  9. Endovascular Treatment of Aneurysms Arising from the Basilar Artery Trunk and Branches

    PubMed Central

    Yu, J.-L.; Wang, H.-L.; Xu, N.; Xu, K.; Wang, B.; Luo, Q.

    2010-01-01

    Summary This study reports our experience with the endovascular treatment of basilar artery (BA) trunk and branch aneurysms. Subjects included 16 patients with BA trunk and branch aneurysms who underwent endovascular treatment in our hospital from October 2000 to October 2009, including four patients with associated arteriovenous malformation (AVM), two with associated moyamoya disease, one with multiple aneurysms at adjacent sites, and one with a distant aneurysm. Endovascular coil embolization, together with stent or balloon assistance when necessary, or while occluding the parent artery was performed. Associated diseases were managed intraoperatively or in the second stage, or treated with gamma knife radiotherapy, or followed up. Two patients with unsuccessful embolization died of re-rupture at the fourth month and fifth month follow-up. The remaining 14 patients reported good outcomes and experienced no re-rupture of either the aneurysm or associated disease. Angiographic follow-ups were conducted for the 14 patients for six to 12 months. Digital subtraction angiography (DSA) examination at the last follow-up showed no recurrence of the BA trunk and branch aneurysms. Together, BA trunk and branch aneurysms should be actively managed via endovascular techniques to prevent serious consequences due to aneurysm rupture and bleeding. Favorable outcomes can be obtained by the proper selection of endovascular treatment regimens. PMID:21162767

  10. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    SciTech Connect

    Euringer, Wulf; Suedkamp, Michael; Rylski, Bartosz; Blanke, Philipp

    2012-08-15

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.

  11. Local anaesthesia for endovascular repair of infrarenal aortic aneurysms.

    PubMed

    Geisbüsch, P; Katzen, B T; Machado, R; Benenati, J F; Pena, C; Tsoukas, A I

    2011-10-01

    The study aimed to analyse and report the results of a 'local anaesthesia first' approach in elective endovascular aneurysm repair (EVAR) patients. Between January 2007 and August 2010, a total of 217 continuous patients (187 men, median age 76 years, range 52-94 years) underwent elective EVAR using this approach, with predefined exclusion criteria for local anaesthesia (LA). A retrospective analysis regarding technical feasibility, mortality, complication and endoleak rate was performed. The results are reported as an observational study. LA was applied in 183 patients (84%), regional anaesthesia (RA) in nine patients (4%) and general anaesthesia (GA) in 25 patients (12%). Anaesthetic conversion from LA to GA was necessary in 14 patients (7.6%). Airway obstruction (n = 4) and persistent coughing (n = 3) were the most common causes for conversion to GA. Thirty-day mortality in the LA group was 2.7%, with 16/183 patients (8.7%) experiencing postoperative complications. All type I endoleaks (n = 5, 2.7%) occurred in patients with LA and challenging aneurysm morphologies. A 'local anaesthesia first' strategy can successfully be applied in 75% of patients undergoing EVAR. The use of LA can impact imaging quality and thus precise endograft placement, which should be considered in patients with challenging aneurysm morphologies. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  12. Complete regression of a symptomatic, mycotic juxtarenal abdominal aortic aneurysm after treatment with fenestrated endovascular aneurysm repair.

    PubMed

    Durgin, Jonathan M; Arous, Edward J; Kumar, Shivani; Robinson, William P; Simons, Jessica P; Schanzer, Andres

    2016-09-01

    Mycotic abdominal aortic aneurysms are rare and present unique challenges when potential treatment options are considered. Although aortic resection with in situ grafting techniques or extra-anatomic reconstruction are the treatments of choice, endovascular aortic repair has emerged as a suitable alternative in critically ill patients. We report the successful endovascular repair of a symptomatic, mycotic juxtarenal aortic aneurysm using a physician-modified fenestrated endograft. In this patient, with >6 months of follow-up, the aneurysm has completely regressed, illustrating that in select patients with complex mycotic aneurysms, endovascular repair combined with appropriate medical management is a viable treatment strategy. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Electronic database for documentation of microsurgical and endovascular treatment of intracranial aneurysms: technical note.

    PubMed

    Gruber, A; Killer, M; Bavinzski, G; Richling, B

    2001-06-01

    The authors present an electronic database for the documentation and inter-group comparison of patients subjected to microsurgical and/or endovascular therapy of ruptured and unruptured intracranial aneurysms.

  14. Effectiveness of open versus endovascular abdominal aortic aneurysm repair in population settings: A systematic review of statewide databases.

    PubMed

    Williams, Christopher R; Brooke, Benjamin S

    2017-10-01

    Patient outcomes after open abdominal aortic aneurysm and endovascular aortic aneurysm repair have been widely reported from several large, randomized, controlled trials. It is not clear whether these trial outcomes are representative of abdominal aortic aneurysm repair procedures performed in real-world hospital settings across the United States. This study was designed to evaluate population-based outcomes after endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair using statewide inpatient databases and examine how they have helped improve our understanding of abdominal aortic aneurysm repair. A systematic search of MEDLINE, EMBASE, and CINAHL databases was performed to identify articles comparing endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using data from statewide inpatient databases. This search was limited to studies published in the English language after 1990, and abstracts were screened and abstracted by 2 authors. Our search yielded 17 studies published between 2004 and 2016 that used data from 29 different statewide inpatient databases to compare endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair. These studies support the randomized, controlled trial results, including a lower mortality associated with endovascular aortic aneurysm repair extended from the perioperative period up to 3 years after operation, as well as a higher complication rate after endovascular aortic aneurysm repair. The evidence from statewide inpatient database analyses has also elucidated trends in procedure volume, patient case mix, volume-outcome relationships, and health care disparities associated with endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair. Population analyses of endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using statewide inpatient databases have confirmed short- and long-term mortality outcomes obtained from

  15. Aneurysm Wall Enhancement Detected by Contrast Computed Tomography Scan Is Associated With Aneurysm Shrinkage After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm.

    PubMed

    Ito, Eisaku; Toya, Naoki; Fukushima, Soichiro; Murakami, Yuri; Akiba, Tadashi; Ohki, Takao

    2017-09-27

    Aneurysm expansion, and consequent endoleaks, after endovascular aneurysm repair (EVAR) is a major problem. Accurate prediction of aneurysm expansion is demanding for surgeons and remains difficult.Methods and Results:We retrospectively analyzed 157 cases of EVAR for abdominal aortic aneurysm (AAA) using a bifurcated main-body stent-graft. There were 62 cases of aneurysm shrinkage after EVAR, 63 cases of stable aneurysm, and 32 cases of aneurysm expansion. Type I endoleaks were significantly increased in the aneurysm expansion group (EXP) compared with the stable (STB) and shrinkage (SHR) groups (EXP: 15.6% vs. STB: 4.8% vs. SHR: 0%, P=0.005). Type II endoleaks were also significantly increased in EXP (EXP: 65.6% vs. STB: 36.5% vs. SHR: 6.5%, P<0.001). Aneurysm wall enhancement (AWE) on imaging, however, was significantly decreased in the EXP group (EXP: 18.8% vs. STB: 23.8% vs. SHR: 53.2%, P<0.001). In multivariate analysis, the occurrence of type II endoleaks significantly decreased (P<0.001) and that of AWE significantly increased the likelihood of aneurysm shrinkage (P=0.032). AWE following EVAR may be associated with aneurysm shrinkage.

  16. Endovascular Management of Ruptured Distal Anterior Cerebral Artery (Daca) Aneurysms: A Retrospective Review Study.

    PubMed

    Husain, Shakir; Andhitara, Yovita; Jena, Somnath Prasad; Padilla, Jorge; Aritonang, Sahat; Letsoin, Igor

    2017-08-17

    Distal anterior cerebral artery (DACA) aneurysms are rare and their treatment by both surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains as a challenge in their management. To review clinical presentation, angiographic presentation of DACA aneurysms, complication and outcome of their endovascular treatment in our institutional experience. Retrospective review study among 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We reported clinical presentations, cerebral angiographic findings, endovascular treatment, complications and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and Raymond scale, respectively. Of 11 patients, 54.5% were female and 45.5% were male with mean age was 48.4 years (33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All of DACA aneurysms were small size. Post-coiling angiograms showed complete occlusion in 9 patients. Two patients had intra-procedural aneurysm rupture but without any clinical sequelae and 1 patient had thrombus formation which was thrombolysed at the end of coiling. All patients had good outcome. Our experience with 11 patients showed endovascular management of small DACA aneurysms though associated with higher intra-procedural events, is associated with good outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Epithelioid Angiosarcoma With Metastatic Disease After Endovascular Therapy of Abdominal Aortic Aneurysm

    SciTech Connect

    Schmehl, Joerg; Scharpf, Marcus; Brechtel, Klaus; Kalender, Guenay; Heller, Stephan; Claussen, Claus D.; Lescan, Mario

    2012-02-15

    Malignancies of the aortic wall represent a rare condition, and only a few reports have covered cases of sarcomas arising at the site of a prosthesis made of Dacron. A coincidence with endovascular repair has only been reported in one case to date. We report a patient with epithelioid angiosarcoma and metastatic disease, which was found in an aneurysmal sac after endovascular aortic repair for abdominal aortic aneurysm.

  18. [Endovascular approach in the management of intracranial aneurysms. Part 1: basic concepts and devices].

    PubMed

    Santos Franco, Jorge Arturo; Zenteno, Marco; Lee, Angel; Viñuela, Fernando; Modenesi Freitas, José María; Vega Montesinos, Susana

    2012-01-01

    Neurological endovascular therapy is a discipline that has shown effectiveness and safety in the management of intracranial aneurysms, however recanalization persists as one of the most important obstacles to overcome. Precise knowledge of the anatomy and hemodynamics of the aneurysm and the parent artery as well as currently available endovascular devices, are decisive in the analysis and to design a specific treatment plan for each case. In this manner we ensure, as long as possible, success and durability of the treatment.

  19. Technical strategy in endovascular treatment of proximal anterior cerebral artery aneurysms.

    PubMed

    Chang, Hyuk Won; Youn, Sung Won; Jung, Cheolkyu; Kang, Hyun-Seung; Sohn, Chul Ho; Kwon, Bae Ju; Han, Moon Hee

    2011-02-01

    There have been few reports on the endovascular treatment of aneurysms arising from A1 due to their rarity. We report the angiographic results, clinical outcomes, and technical aspects of endovascular treatment for 13 A1 aneurysms in 12 patients. From January 2002 to November 2007, 12 patients (9 females and 3 males) with 13 A1 aneurysms underwent endovascular treatment. Three of these patients presented with subarachnoid hemorrhage, and 10 unruptured aneurysms were detected in 9 patients. All of the aneurysms were successfully treated with coil embolization. Most of the aneurysms projected posteriorly (61.5%) and were located in the proximal A1 segment (69.2%). Procedural, clinical, and radiological follow-up data were reviewed. Procedure-related complications occurred in 3 patients (25%) and included 1 non-leaking aneurysmal perforation and 2 thromboembolic events; none of them were clinically significant. No bleeding or rebleeding occurred during the follow-up period in this cohort of patients. Endovascular coil embolization is an effective treatment modality for A1 aneurysms. Tailored microcatheter shaping according to aneurysm projection and location is necessary. Long-term follow-up studies involving a larger number of patients and further comparisons with surgical data are needed.

  20. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    SciTech Connect

    Koike, Yuya Nishimura, Jun-ichi Hase, Soichiro Yamasaki, Motoshige

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  1. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-10-15

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 {+-} 0.10 after main-body deployment, 0.63 {+-} 0.12 after leg deployment (P < 0.01), and 0.56 {+-} 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 {+-} 21 mmHg, 23 {+-} 15 mmHg (P < 0.01), and 16 {+-} 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 {+-} 0.13 vs. 0.54 {+-} 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 {+-} 0.10 to 0.55 {+-} 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 {+-} 0.12 vs. 0.55 {+-} 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 {+-} 0.12 vs. 0.57 {+-} 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  2. Anterior Retroperitoneal Spine Exposure following Prior Endovascular Aortic Aneurysm Repair.

    PubMed

    Ullery, Brant W; Thompson, Patrick; Mell, Matthew W

    2016-08-01

    We describe successful anterior retroperitoneal spine exposure to facilitate anterior lumbar interbody fusion (ALIF) in a patient with a prior endovascular aneurysm repair (EVAR). A 74-year-old male with an extensive spine surgical history presented with progressive neurogenic claudication and paresthesia involving both feet. In addition, his surgical history was notable for an EVAR performed elsewhere 5 years earlier, with subsequent right renal stent placement for encroachment of the right renal artery. Diagnostic evaluation identified severe L3-4 and L4-5 canal stenosis, and a 48 × 36-mm aneurysm sac with a type II endoleak. Revision L3-L5 fusion from an anterior approach with vascular surgery assistance was recommended. The retroperitoneum was accessed through a left paramedian abdominal incision. The abdominal aortic aneurysm sac was visualized and noted to be nonpulsatile. The distal aorta and left iliac vessels were dissected and retracted medially to facilitate anterior exposure of the L3-4 and L4-5 disk spaces. Successful ALIF of the L3-5 vertebrae was then performed. Retractors were removed and the aortoiliac vessels were carefully returned to anatomic position. The aneurysm sac remained nonpulsatile, with normal pulses in the iliac arteries. Postoperative imaging demonstrated stable appearance of aortic stent graft. At 1-year follow-up, the patient reports complete resolution of symptoms and imaging demonstrates a patent aortic stent graft with a stable type II endoleak. Widespread application of ALIF will inevitably include an increasing subgroup of patients with previous EVAR. Such patients require thorough clinical and radiographic perioperative considerations for the access surgeon. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement.

    PubMed

    Png, Chien Yi M; Tadros, Rami O; Beckerman, William E; Han, Daniel K; Tardiff, Melissa L; Torres, Marielle R; Marin, Michael L; Faries, Peter L

    2017-09-01

    Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs. 895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables. Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033). Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Endovascular treatment of proximal arsastomotic aneurysms after aortic prosthetic reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudo-aneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n=1), bifurcated graft (n=s1)]. In one patient an uniiliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  5. [Role of anesthesiologist in endovascular management of intracranial aneurysms].

    PubMed

    Murselović, Tamara; Adanić Mikloska, Ines; Bajić Rifai, Miroslava; Majerić Kogler, Visnja

    2008-02-01

    The aim is to give a review of the anesthesiological approach to neuroradiological endovascular treatment of intracranial aneurysm in Croatia since 2004, when the first procedure was done. It took place at University Department of Radiology, Zagreb University Hospital Center. The optimal conduct of anesthesia in the neuroradiology suite requires careful planning of each individual procedure. Essential components are detailed patient evaluation and due understanding of the underlying neuropathology. An open channel of communication between the radiologist and the anesthesiologist is important for routine care but is crucial in case of disasters that may occur during the procedure. In the patient management the basic principles of neuroanesthesia cannot be avoided. This includes optimization of CBF, perfusion pressure, control of intracranial pressure (ICP) and close monitoring of blood pressure (BP), fluid status and body temperature. The choice of anesthetic agents and techniques remains in the hands of the anesthesiologist. The needs of the neuroradiologist and the procedure have to be considered. Most institutions have their protocols and some favor conscious sedation whereas others prefer general anesthesia. There is little evidence in favor of either technique. The better image quality obtained from the motionless patient during digital subtraction angiography favors the use of general anesthesia over any other technique. Since the procedure is becoming very complex, the need for precise BP control and preparation for potential catastrophic complication are considerations for general anesthesia. Aneurysm rupture during endovascular procedures is not common but remains a potential risk. The incidence ranges from 2.3% to 3% and even higher in patients with already ruptured aneurysms. The mortality rate is up to 20% in case of rupture, especially if massive subarachnoid hemorrhage occurs. Anesthesiologic treatment depends on the severity of bleeding and includes

  6. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  7. Endovascular Treatment of Femoropopliteal Aneurysms: A Five-Year Experience

    SciTech Connect

    Lagana, Domenico Carrafiello, Gianpaolo; Mangini, Monica; Caronno, Roberto; Giorgianni, Andrea; Lumia, Domenico; Castelli, Patrizio; Fugazzola, Carlo

    2006-10-15

    Purpose. To assess the effectiveness of endovascular treatment of femoropopliteal aneurysms (FPAs). Methods. In the last 5 years, we have treated 17 FPAs (diameter 21-75 cm, mean 38.4 cm; length 27-100 cm, mean 72.5 cm) in 15 patients (age 57-80 years, mean 70.9 years). The diagnosis was obtained by color Doppler ultrasound (CDU) and the procedure was planned by CT angiography (CTA) and preprocedural angiography. Eight FPAs were excluded with only one stent-graft; in 8 patients, two stent-grafts were positioned; and in 1 patient, three stent-grafts were used. In 14 cases we used a Wallgraft endoprosthesis, in 2 cases a Hemobahn, and in 1 case an Excluder contralateral leg. The patients were followed up with CDU and occasionally with CTA. Results. Immediate technical success was obtained in 17 of 17 cases (100%). One patient died during the first year. During a mean follow-up of 26.9 months (range 3-60 months) we observed 6 of 16 (38%) stent-graft occlusions (3 of which were recanalized with locoregional thrombolysis and 3 with mechanical thrombectomy). Two stent-grafts were patent at 12 and 24 months. Four patients experienced subsequent occlusions and recanalizations until corrected by surgical bypass (1 at 14 months, 2 at 18 months, and 1 at 36 months). Therefore the primary patency was 63% and assisted patency was 73%. Conclusion. The endovascular approach is a minimally invasive treatment option for FPAs. Moreover endovascular stent-grafting does not necessarily preclude conventional surgical repair, but it can delay it. Longer follow-up will be needed to determine the long-term patency rate.

  8. Multiple mycotic aneurysms due to penicillin nonsusceptible Streptococcus pneumoniae solved with endovascular repair.

    PubMed

    Rojas, Alvaro; Mertens, Renato; Arbulo, Douglas; Garcia, Patricia; Labarca, Jaime

    2010-08-01

    Mycotic aneurysm is a life-threatening condition. We report the case of an 83-year-old white female who had pneumonia, and 3 months later she was admitted with multiple sacular mycotic aneurysms due to penicillin nonsusceptible Streptococcus pneumoniae. Successful combination therapy with antibiotics and endovascular repair was done.

  9. Post-endovascular aneurysm repair (EVAR) testicular ischemia: A rare complication.

    PubMed

    Thomas, Eric; Parra, Brett L; Patel, Shonak

    2017-09-01

    Endovascular aneurysm repair (EVAR) is a common modality of treating abdominal aortic aneurysms (AAA). Common complications include endoleak, bleeding, infection, contrast related injuries, and ischemia. We present the case of a patient who experienced a testicular infarction following repair of an infrarenal AAA. We also discuss the implications for this complication and review the available literature for similar cases and treatment options.

  10. Endovascular repair of multiple infrageniculate aneurysms in a patient with vascular type Ehlers-Danlos syndrome.

    PubMed

    Domenick, Natalie; Cho, Jae S; Abu Hamad, Ghassan; Makaroun, Michel S; Chaer, Rabih A

    2011-09-01

    Patients with vascular type Ehler-Danlos syndrome can develop aneurysms in unusual locations. We describe the case of a 33-year-old woman with vascular type Ehlers-Danlos syndrome who developed metachronous tibial artery aneurysms that were sequentially treated with endovascular means.

  11. Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

    SciTech Connect

    Ruebben, Alexander; Tettoni, Serena; Muratore, Pierluigi; Rossato, Dennis; Savio, Daniele; Rabbia, Claudio

    1998-07-15

    To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.

  12. Progression of perianeurysmal inflammation after endovascular aneurysm repair for inflammatory abdominal aortic and bilateral common iliac artery aneurysms.

    PubMed

    Igari, Kimihiro; Kudo, Toshifumi; Uchiyama, Hidetoshi; Toyofuku, Takahiro; Inoue, Yoshinori

    2015-02-01

    The use of endovascular aneurysm repair (EVAR) to treat inflammatory abdominal aortic aneurysms (IAAAs) has been reported, and this procedure appears to be preferable to open surgical repair because of intraoperative difficulties related to inflammation. We herein report a case of IAAA and bilateral inflammatory common iliac artery aneurysms that was successfully treated with bifurcated stent grafting. The perianeurysmal inflammation worsened postoperatively, requiring the placement of a ureteric stent. EVAR is feasible in cases of inflammatory aneurysms; however, the potential for an inflammatory response should be taken into account when considering the application of EVAR in patients with IAAA.

  13. Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

    PubMed Central

    Liu, Peng; Lv, Xianli; Lv, Ming

    2015-01-01

    We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy. PMID:26472635

  14. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report.

    PubMed

    Hemmati, Hossein; Karimian, Mehdi; Moradi, Habibollah; Farid Marandi, Kambiz; Haghdoost, Afrooz

    2015-07-01

    Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.

  15. Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture.

    PubMed

    Edmonds, Rebecca D; Tomaszewski, Jeffrey J; Jackman, Stephen V; Chaer, Rabih A

    2008-11-01

    We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.

  16. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

    PubMed Central

    Shin, S.H.; Choi, I.S.; Thomas, K.; David, C.A.

    2013-01-01

    Summary Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm. PMID:23693047

  17. [Inflammatory aortic aneurysms: Single center experiences with endovascular repair of inflammatory abdominal aortic aneurysms].

    PubMed

    Strube, H; Treitl, M; Reiser, M; Steckmeier, B; Sadeghi-Azandaryani, M

    2010-10-01

    We report our single center experience of renal function, hydronephrosis and changes in perianeurysmal fibrosis (PAF) after endovascular repair (EVAR) of inflammatory abdominal aortic aneurysms (IAAA). A total of 6 patients were treated for IAAA with EVAR and the technical success was 100%. During the follow-up period 5 patients showed regression of PAF and 1 patient showed minor progression of PAF on computed tomography scans. In 2 patients hydronephrosis was regressive postoperatively but no patients died within 30 days. There were no secondary complications to report and no secondary intervention was necessary. In the long-term course one patient exhibited complete regression of PAF.In appropriate cases EVAR is a safe method for aneurysm repair for IAAA. In patients with acute inflammation or hydronephrosis individual treatment concepts are required.

  18. Imaging After Nellix Endovascular Aneurysm Sealing: A Consensus Document.

    PubMed

    Holden, Andrew; Savlovskis, Janis; Winterbottom, Andrew; van den Ham, Leo H; Hill, Andrew; Krievins, Dainis; Hayes, Paul D; Reijnen, Michel M P J; Böckler, Dittmar; de Vries, Jean-Paul P M; Carpenter, Jeffrey P; Thompson, Matt M

    2016-02-01

    Endovascular aneurysm sealing (EVAS) using the Nellix system is a new and different method of abdominal aortic aneurysm repair. Normal postoperative imaging has unique appearances that change with time; complications also have different and specific appearances. This consensus document on the imaging findings after Nellix EVAS is based on the collective experience of the sites involved in the Nellix EVAS Global Forward Registry and the US Investigational Device Exemption Trial. The normal findings on computed tomography (CT), duplex ultrasound, magnetic resonance imaging, and plain radiography are described. With time, endobag appearances change on CT due to contrast migration to the margins of the hydrogel polymer within the endobag. Air within the endobag also has unique appearances that change over time. Among the complications after Nellix EVAS, type I endoleak usually presents as a curvilinear area of flow between the endobag and aortic wall, while type II endoleak is typically small and usually occurs where an aortic branch artery lies adjacent to an irregular aortic blood lumen that is not completely filled by the endobag. Procedural aortic injury is an uncommon but important complication that occurs as a result of overfilling of the endobags during Nellix EVAS. The optimum imaging surveillance algorithm after Nellix EVAS has yet to be defined but is largely CT-based, especially in the first year postprocedure. However, duplex ultrasound also appears to be a sensitive modality in identifying normal appearances and complications.

  19. Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms – Literature Review

    PubMed Central

    Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

    2016-01-01

    Summary The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates. PMID:27559426

  20. Successful endovascular management of brain aneurysms presenting with mass effect and cranial nerve palsy.

    PubMed

    Hassan, Tamer; Hamimi, Ahmed

    2013-01-01

    Aneurysms presented with mass effect are traditionally treated by surgical clipping to decompress their mass effect. The aim of this work is to discuss the efficiency of endovascular techniques in treating 47 patients with variable sizes of intracranial aneurysms presented with mass effect and/or cranial nerve palsy. There were 47 patients with 47 unruptured aneurysms. Group I includes 28 giant aneurysms; all are treated by parent vessel occlusion with or without intra-aneurysmal occlusion depending on anatomical locations. Group II includes 19 small and large aneurysms; all are treated by selective endosaccular occlusion with coils. Clinical presentations were ocular cranial nerve dysfunction (82.9%), optic nerve or chiasmatic dysfunction (21.2%), brain stem compression (8.5%), embolic (6%), epistaksis (4%), proptosis (2%), and bleeding per ear (2%). Out of 47 patients, symptoms were resolved in 31 cases (66%), improved in 10 cases (21%), and unchanged in six cases (13%). Out of 28 giant aneurysms, symptoms were resolved in 19 (68%), improved in four (14%), and unchanged in five (18%). Only four (14%) patients out of the 19 giant aneurysms with complete symptoms resolution showed significant mass reduction in MRI. Out of 19 non-giant aneurysm cases treated by selective endovascular occlusion with coils, symptoms were resolved in 12 cases (63%), improved in six (32%), and unchanged in one (5%). No complications from the treatment were observed. The longer the duration of symptoms before endovascular treatment is, the longer the duration till improvement or resolution postoperative in both groups. Recovery of aneurysm-induced mass effect occurs in most patients both after parent vessel occlusion and after selective coiling, and is comparable to results after surgical clipping. The improvement starts independent of aneurysmal shrinkage in postoperative MRI follow-ups. The arrest of pulsations and partial shrinkage within the aneurysms after endovascular treatment may

  1. First long-term evidence supporting endovascular repair of abdominal aortic aneurysms.

    PubMed

    Indes, Jeffrey E; Muhs, Bart E; Dardik, Alan

    2013-04-01

    The traditional method of treating abdominal aortic aneurysms with open surgical repair has been steadily replaced by endovascular repair, thought to be a more minimally invasive approach. It is not known, however, whether the endovascular approach is truly less invasive for operative physiology; in addition, this approach has a different spectrum of complications. As such, it is uncertain whether elective endovascular repair of nonruptured aortic aneurysms reduces long-term morbidity and mortality compared with traditional open approaches. In this article, the authors evaluate a recent publication investigating long-term outcomes of a prospective randomized multicenter trial evaluating patients with asymptomatic abdominal aortic aneurysms treated with either endovascular or open repair, and discuss the results in the context of current evidence.

  2. Endovascular Repair of an Anastomotic Leak Following Open Repair of Abdominal Aortic Aneurysm

    SciTech Connect

    Mofidi, R. Flett, M.; Milne, A.; Chakraverty, S.

    2007-09-15

    This report describes the case of an early postoperative anastomotic leak following elective open repair of an infrarenal abdominal aortic aneurysm which was successfully treated by endovascular stent-grafting. A 71-year-old man underwent open tube graft repair of abdominal aortic aneurysm. Twelve days later he presented with a contained leak from the distal anastomosis, which was confirmed on CT scan. This was successfully treated with a bifurcated aortic stent-graft. This case illustrates the usefulness of the endovascular approach for resolving this rare surgical complication of open repair of abdominal aortic aneurysm and the challenges associated with the deployment of such a device within an aortic tube graft.

  3. Hybrid Thoracic Endovascular Aortic Repair for Intercostal Patch Aneurysm after Thoracoabdominal Aortic Replacement.

    PubMed

    Kitahara, Hiroto; Yoshitake, Akihiro; Hachiya, Takashi; Okamoto, Kazuma; Hirano, Akinori; Kasai, Mio; Akamatsu, Yuta; Oka, Hidetoshi; Shimizu, Hideyuki

    2015-01-01

    We report a case of hybrid thoracic endovascular aortic repair for intercostal patch aneurysm after thoracoabdominal aortic replacement. Eighteen years ago, a 63-year-old woman with Marfan syndrome had undergone thoracoabdominal aortic replacement with reimplantation of the intercostal artery in an island fashion. Follow-up computed tomography (CT) revealed a remaining intercostal patch aneurysm of diameter 60 mm 17 years after the last operation. Hybrid thoracic endovascular aortic repair for exclusion of this intercostal patch aneurysm was successfully performed, with visceral artery bypasses. Postoperative CT showed no anastomotic stenosis or endoleak.

  4. Calcium channel blockers enhance sac shrinkage after endovascular aneurysm repair.

    PubMed

    Bailey, Marc A; Sohrabi, Soroush; Flood, Karen; Griffin, Kathryn J; Rashid, S Tawqeer; Johnson, Anne B; Baxter, Paul D; Patel, Jai V; Scott, D Julian A

    2012-06-01

    Sac shrinkage is a surrogate marker of success after endovascular aneurysm repair (EVAR). We set out to determine if any common cardioprotective medications had a beneficial effect on sac shrinkage. This retrospective observational study took place at Leeds Vascular Institute, a tertiary vascular unit in the Northern United Kingdom. The cohort comprised 149 patients undergoing EVAR between January 1, 2005, and December 31, 2008. Medication use was recorded at intervention (verified at study completion in 33 patients), and patients were monitored for 2 years. The main outcome measures were the effect of medication on sac shrinkage as determined by percentage change in maximal idealized cross-sectional area of the aneurysm at 1 month, 6 months, 1 year, and 2 years by linear regression model, in addition to 2-year endoleak and death rates determined by a binary logistic regression model. After exclusions, 112 patients, who were a median age of 78 years (interquartile range, 78-83 years), remained for analysis. The median Glasgow Aneurysm Score was 85 (interquartile range, 79-92). At 2 years, mortality was 13.4%, endoleak developed in 37.5%, and significant endoleak developed in 14.3%. Patients taking a calcium channel blocker had enhanced sac shrinkage, compared with those not taking a calcium channel blocker, by 6.6% at 6 months (-3.0% to 16.3%, P = .09), 12.3% at 1 year (2.9% to 21.7%, P = .008), and 13.1% at 2 years (0.005% to 26.2%, P = .007) independent of other medication use, graft type, endoleak development, or death. Enhanced sac shrinkage occurred after EVAR in patients taking calcium channel blockers. This warrants further study in other centers and at the molecular level. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  5. ENDOVASCULAR AORTIC ANEURYSM REPAIR AT JOHANNESBURG ACADEMIC HOSPITALS.

    PubMed

    Thomas, K; du Toit, R; Abdool-Carrim, A T O

    2017-09-01

    Abdominal aortic aneurysm (AAA) is a common disease seen in vascular units. AAA is defined as transverse diameter greater than 3 cm and affects men more than women. Endovascular aortic aneurysm repair (EVAR) is increasingly being used to treat AAA. Renal dysfunction, graft-related endoleaks, graft limb occlusion, device migration and delayed aneurysm rupture are possible complications that have been encountered after EVAR. Changes in renal functions after one month, six months and twelve months. The incidence of endoleaks, limb occlusion and re-interventions required. Total of thirty-six patients had EVAR done from February 2014 to April 2017. There were two patients who had type 2 endoleaks on completion angiograms, these resolved on one month CT scan. Fourteen patients had post-EVAR imaging at 1, 6 and 12 months which showed no endoleaks. Three patients developed iliac limb occlusion and was appropriately managed with fem-fem crossover. Eight patients had preexiting renal impairment with worsening of renal function in one patient (not requiring dialysis). Three patients developed renal impairment after EVAR. Twenty-two patients are waiting for the follow up imaging and few patients missing follow-up blood tests - this data will be added before the congress. The follow-up data demonstrates that EVAR can be performed safely in anatomically suitable patients. The limb occlusion rates are within accepted rates to standard vascular registry. The patients who developed renal dysfunction (Glomerular filtration rate between 50-60ml/min/1.73m2) after EVAR remained static for 12 months.

  6. An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess

    PubMed Central

    Gülcü, Aytaç; Gezer, Naciye Sinem; Uğurlu, Şevket Baran; Göktay, Ahmet Yiğit

    2016-01-01

    Mycotic aortic aneurysms account for 1–3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm. PMID:27365559

  7. Endovascular treatment of multiple anomalous splenic artery aneurysms in a Jehovah witness.

    PubMed

    Borioni, R; De Persio, G; Leporace, M; Di Capua, C; Boggi, U; Garofalo, M

    2013-01-01

    The present report describes a full endovascular treatment of a multiple anomalous (Splenic artery aneurysms) SAA with combination of coils embolization and proximal occlusion of the splenic artery with the Amplatzer vascular plug. A 53-year-old Jehovah witness woman presented with multiple aneurysms arising from an anomalous splenic artery. An endovascular treatment was performed by implantation of multiple coils and an Amplatzer Vascular Plug. A CT scan 2 months after the procedure showed complete thrombosis of the aneurysms. Aneurysms involving an anomalous or aberrant splenic artery are rarely reported in the literature. Their surgical treatment involves potential difficulties as a consequence of anatomical position and vascular anomalies. A fully endovascular technique can be much more attractive compared to any surgical management, providing an effective and minimally invasive option.

  8. Aortobronchial Fistula after Thoracic Endovascular Aortic Repair (TEVAR) for Descending Thoracic Aortic Aneurysm.

    PubMed

    Melvan, John Nicholas; DeLaRosa, Jacob; Vasquez, Julio C

    2017-03-07

    Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.

  9. Successful Treatment of Clostridium difficile Bacteremia with Aortic Mycotic Aneurysm in a Patient with Prior Endovascular Aortic Aneurysm Repair

    PubMed Central

    Brauch, Rebecca; Cherabuddi, Kartikeya

    2017-01-01

    The clinical spectrum of Clostridium difficile infection can range from benign gastrointestinal colonization to mild diarrhea and life threatening conditions such as pseudomembranous colitis and toxic megacolon. Extraintestinal manifestations of C. difficile are rare. Here, we report a patient with a history of an endovascular aortic aneurysm repair (EVAR) presenting with an endovascular leak complicated by C. difficile bacteremia and a mycotic aneurysm. He was successfully treated with an explant of the EVAR, an aorto-left renal bypass, and aorto-bi-iliac bypass graft placement along with a six-week duration of intravenous vancomycin and oral metronidazole. PMID:28348903

  10. Percutaneous endovascular management of atherosclerotic axillary artery stenosis: Report of 2 cases and review of literature.

    PubMed

    Vijayvergiya, Rajesh; Yadav, Mukesh; Grover, Anil

    2011-05-26

    With recent advancement in percutaneous endovascular management, most atherosclerotic peripheral arterial diseases are amenable for intervention. However, there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management. We report two cases of atherosclerotic axillary artery stenosis, which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting. The long term follow-up revealed patent axillary stents in both cases.

  11. Importance of independent evaluation of initial anatomic results after endovascular coiling for ruptured cerebral aneurysms.

    PubMed

    Taki, Waro; Sakai, Nobuyuki; Suzuki, Hidenori

    2013-04-01

    Initial incomplete occlusion is been an important predictor of aneurysm recurrence, rebleeding or retreatment after endovascular coiling. In 129 patients in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, ruptured aneurysms were coiled within 14days of onset, and initial post-coiling and 1-year follow-up aneurysm-occlusion status were evaluated by both local investigators and independent reviewers. The aim of this study was to investigate whether self-reported evaluations of initial aneurysm occlusion by treating physicians predicted incomplete aneurysm occlusion at 1year after coiling for ruptured cerebral aneurysms as well as that done by independent evaluations. The relationships between self-reported or independent evaluations of initial anatomic results and 1-year incomplete aneurysm occlusion (retreatment within 1year, or residual aneurysms at 1year) were determined. Both initial and 1-year aneurysm-occlusion status were judged significantly worse by independent reviewers than by local investigators (p<0.001). One-year incomplete aneurysm occlusion was identified in 59 patients: 10 patients, including two patients with re-ruptured aneurysms, were retreated and 49 other patients were judged to have residual aneurysms by independent reviewers. On immediate post-coiling angiograms, both residual neck or aneurysm judged by local investigators, and residual aneurysm judged by independent reviewers, were predictive for 1-year incomplete aneurysm occlusion on univariate analyses. However, multivariate analyses found that the initial aneurysm occlusion status judged by independent reviewers (p=0.02, odds ratio=2.83, 95% confidence interval=1.15-6.95), but not by local investigators, was a significant predictor for 1-year incomplete aneurysm occlusion. This study demonstrates the importance of independent evaluations of aneurysm occlusion status for management of coiled aneurysms.

  12. White-collar sign as a predictor of outcome after endovascular treatment for cerebral aneurysms.

    PubMed

    Fukuda, Kenji; Higashi, Toshio; Okawa, Masakazu; Iwaasa, Mitsutoshi; Yoshioka, Tsutomu; Inoue, Tooru

    2017-03-01

    OBJECTIVE The white-collar sign (WCS) is known as a thick neointimal tissue formation at the aneurysm neck after endovascular coil embolization of cerebral aneurysms, which may prevent aneurysm recanalization. The purpose of this study was to evaluate factors involved in the appearance of WCS and to identify radiological and clinical outcomes of treated aneurysms with WCS. METHODS The study included 140 patients with 149 aneurysms in which it was possible to confirm the aneurysm neck between the aneurysm sac and parent artery by using conventional angiography. The WCS was defined as a radiolucent band at the aneurysm neck on the angiogram at 6 months after initial embolization. The radiological outcome was evaluated using MR angiography. RESULTS In 23 of 149 aneurysms (15.4%), a WCS appeared. The WCS-positive group had a significantly smaller neck size (3.3 ± 0.8 mm vs 4.2 ± 1.1 mm, p < 0.001) and smaller aneurysm size (4.3 ± 0.9 mm vs 6.0 ± 2.1 mm, p < 0.001) than the WCS-negative group. Multivariate analysis revealed that WCS appearance was associated with small neck size (OR 0.376, 95% CI 0.179-0.787; p = 0.009). In 106 of 149 aneurysms, the rate of complete occlusion was significantly higher in the WCS-positive group (18/18, 100%) than in the WCS-negative group (n = 54/88, 61.4%; p = 0.001) in the mean follow-up period of 31.0 ± 9.7 months (range 5-52 months). Neither major recanalization nor rupture of the aneurysm occurred in the WCS-positive group. CONCLUSIONS Appearance of the WCS was associated with complete occlusion and good clinical outcome after endovascular coil embolization. The WCS would help to determine the prognosis of cerebral aneurysms after endovascular treatment.

  13. Emergency Endovascular Management of Pulmonary Artery Aneurysms In Behcet's Disease: Report of Two Cases and a Review of the Literature

    SciTech Connect

    Cantasdemir, Murat; Kantarci, Fatih; Mihmanli, Ismail; Akman, Canan; Numan, Furuzan; Islak, Civan; Bozkurt, A. Kursat

    2002-12-15

    his report describes two patients with a known history of Behcet's disease in whom massive hemoptysis developed from rupture of pulmonary artery aneurysms. The high recurrence rate of complications related to pulmonary artery aneurysms and even the aneurysms themselves due to inadequacy of medical therapy and the disadvantages of surgical treatment make these aneurysms candidates for endovascular management.The pulmonary artery aneurysms reported here were successfully treated with endovascular embolization using n-butylcyanoacrylate. Pulmonary artery aneurysm embolization in Behcet's disease has been reviewed in the light of relevant literature.

  14. Endovascular Treatment of Giant Serpentine Aneurysm of the Middle Cerebral Artery

    PubMed Central

    Jeong, Young Ha; Koo, Youn Moo; Choi, Jong Wook; Whang, Kum; Hu, Chul; Cho, Sung Min

    2016-01-01

    Giant serpentine aneurysms are uncommon types of aneurysmal disease and have angiographically authentic features. We report a case of a 44-year-old male with headache and seizure. He presented a giant serpentine aneurysm arising from the middle cerebral artery (MCA). It was a large intracranial aneurysm thrombosed as a mass-like lesion while it maintained its outflow drainage into the distal MCA branches. The balloon occlusion test (BOT) was performed to test the tolerance of temporary collateral circulation. Following routine cerebral angiography, we performed an endovascular embolization on the proximal artery of MCA. He was discharged from the hospital with alert mental status and mild Gerstmann syndrome. The short-term follow-up imaging studies showed the decreased mass effect, and the patient presented an improved Gerstmann syndrome. After a careful evaluation of BOT, an endovascular embolization can be one of the powerful therapeutic instruments for giant serpentine aneurysm. PMID:27847772

  15. Endovascular coil embolization for ruptured kissing aneurysms associated with A1 fenestration.

    PubMed

    Mitsuhara, Takafumi; Sakamoto, Shigeyuki; Kiura, Yoshihiro; Kurisu, Kaoru

    2011-01-01

    Fenestration of intracranial arteries is a rare anomaly, and is frequently associated with cerebral aneurysms. In this paper, we report rare kissing aneurysms associated with A1 fenestration. A 71-year-old woman presented with subarachnoid hemorrhage. Diagnostic digital subtraction angiography revealed two saccular aneurysms at the proximal junction of a fenestration and posterior aspect of the fenestration that appeared to be 'kissing' each other. Emergent endovascular coil embolization was performed. Kissing aneurysms associated with fenestration of the horizontal segment in the anterior cerebral artery are rare, and have not been reported. During treatment of such specific types of aneurysms by endovascular treatment, three-dimensional rotational digital subtraction angiography was very useful for deciding the appropriate working angles.

  16. Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

    PubMed Central

    Amin-Hanjani, Sepideh; Goodin, Sean; Charbel, Fady T.; Alaraj, Ali

    2014-01-01

    Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery–middle cerebral artery bypass is another potential strategy for resolution of these aneurysms. Case Description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm. Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms. PMID:25071939

  17. Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

    PubMed Central

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.

    2015-01-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  18. Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair.

    PubMed

    Lala, Salim; Knowles, Martyn; Timaran, David; Baig, Mirza Shadman; Valentine, James; Timaran, Carlos

    2016-09-01

    The Zenith (Cook Medical, Bloomington, Ind) fenestrated endovascular graft may be designed with single-wide scallops or large fenestrations to address the superior mesenteric artery (SMA). Misalignment of the SMA with an unstented scallop or a large fenestration is possible. This study assessed SMA outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR). During an 18-month period, 47 FEVARs were performed at a single institution. For analysis, patients were grouped according to unstented (n = 23) vs stented (n = 24) SMA scallops/fenestrations. The Institutional Review Board approved this single-institution observational study. Because this was a retrospective review of the data, patient consent was unnecessary for the study. Technical success for FEVAR was 100%. The median follow-up period was 7.7 months (range, 1-16 months). Nine of 21 patients (43%) in the unstented group had some degree of misalignment of the SMA (range, 9%-71%). Among these, four patients (44%) developed complications: three SMA stenoses and one occlusion. The mean peak systolic velocity in patients with and without SMA misalignment was 317.8 cm/s vs 188.4 cm/s (P < .08), respectively. No misalignment occurred in the stented group, and only one of 19 patients (5%) developed an SMA stenosis that required angioplasty. Overall, patients with unstented SMAs had significantly more adverse events directly attributable to SMA misalignment than the stented group (44% vs 5%, respectively; P < .05). Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  19. Systemic Inflammatory Response and Severe Thrombocytopenia after Endovascular Thoracic Aortic Aneurysm Repair

    PubMed Central

    Silvestrin, Valentina; Bonvini, Stefano; Antonello, Michele; Grego, Franco; Vettor, Roberto

    2017-01-01

    After Endovascular repair of thoracic aortic aneurysm, a systemic inflammatory response, named postimplantation syndrome, can develop. This syndrome is characterized by fever, leukocytosis, and elevated CRP plasma levels and its pathogenetic mechanisms are still unknown. Although this syndrome generally resolves within few days, some patients develop a persisting severe inflammatory reaction leading to mild or severe complications. Here we describe the case of a male patient who developed postimplantation inflammatory syndrome and severe thrombocytopenia after endovascular repair of thoracic aortic aneurysm. Treatment with prednisone (50 mg/bid) for two weeks did not improve the clinical and laboratory findings. We utilized danazol, a weak androgen that has been shown to be effective in the treatment of immune and idiopathic thrombocytopenic purpura, and after 12 days of treatment with danazol (200 mg/bid), the patient improved progressively and platelet number increased up to 53,000/μL. Patients undergoing endovascular repair of thoracic aortic aneurysm should be carefully monitored for the development of postimplantation syndrome. This clinical condition is relatively common after the endovascular repair of aortic aneurysm but is rarely observed after endovascular repair of thoracic aortic aneurysms. The different known therapeutical approaches are still empiric, with reported beneficial effects with the use of NSAID, corticosteroids, and danazol. PMID:28154580

  20. Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage.

    PubMed

    James Ling, Adrian; D'Urso, Paul Steven; Madan, Anoop

    2006-08-01

    Most aneurysms can be effectively managed using endovascular coiling or microsurgical clipping, but in an acute subarachnoid haemorrhage where there are multiple aneurysms identified, a sequential multimodal approach may prove more beneficial. This report involves a 31-year-old man who presented with sudden onset of severe headache and photophobia. A computed tomography brain scan revealed a diffuse grade II subarachnoid haemorrhagic pattern, and four-vessel angiography revealed two aneurysms: a right middle cerebral artery bifurcation aneurysm measuring 12 x 8 mm and a 4-mm basilar artery aneurysm associated with a fenestration at the confluence of the vertebral arteries. It was not possible to determine which aneurysm or aneurysms were responsible for the haemorrhage using the customary criteria. The patient underwent sequential endovascular coiling of the vertebrobasilar aneurysm without delay, followed immediately by microsurgical clipping of the right middle cerebral artery aneurysm, under a single anaesthetic. The postoperative course was uneventful. This method is a treatment option for acute subarachnoid haemorrhage where there are multiple aneurysms. It is a logical progression of management that could be employed at any experienced neurovascular centre; the employment of a sequential multimodal approach from the integration of these techniques is beneficial to the patient because it decreases morbidity and mortality.

  1. Treatment of ruptured middle cerebral artery aneurysms by endovascular approach: a single-center experience.

    PubMed

    Zhao, Xintong; Li, Zhenbao; Fang, Xinggen; Liu, Jiaqiang; Wu, Degang; Lai, Niansheng

    2017-05-01

    The optimal treatment modalities of ruptured middle cerebral artery aneurysm are still controversial. The objective of this study is to analyze the outcomes of patients with ruptured middle cerebral artery aneurysms treated by endovascular coiling. From October 2011 to October 2015, 67 patients with 71 ruptured middle cerebral artery aneurysms received endovascular coiling in our hospital. We retrospectively reviewed the clinical, radiologic records and outcomes. Of all the 71 aneurysms (67 patients), 42 were treated by coil embolization merely, 27 by stent-assisted coiling and 2 unruptured aneurysms in patients with bilateral middle cerebral artery aneurysms without receiving treatment. Complete occlusion was achieved in 82.6% (57/69) of all the procedures. Each of incomplete and partial occlusion rates was 8.7% (6/69). Intraoperative rupture of aneurysms occurred in two procedures (2.9%). Thrombogenesis occurred in eight procedures (11.6%). Brain infarction occurred in eight patients (11.9%). Post-operative rebleeding occurred in seven patients (10.4%). Sixty-three patients were followed at a mean follow-up of 8.24 ± 7.16 months. The mortality and good outcome rate were 3.2% and 90.5%, respectively. Aneurysm recurrence occurred in 6 (13.3%) of the 45 aneurysms at a mean follow-up of 8.44 ± 7.83 months. Endovascular coiling is effective for patients with ruptured middle cerebral artery aneurysms. Individualized treatment should be assessed by experienced specialist. It is essential to perform randomized large trials to confirm the efficiency of endovascular coiling.

  2. Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion

    SciTech Connect

    Carnevale, F. C. De Blas, Mariano; Merino, Santiago; Egana, Jose M.; Caldas, Jose G.M.P.

    2004-09-15

    Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 to 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.

  3. Chronological Change of the Sac after Endovascular Aneurysm Repair

    PubMed Central

    Kim, Min Hyun; Park, Hyung Sub; Ahn, Sanghyun; Min, Sang-Il; Min, Seung-Kee; Ha, Jongwon; Lee, Taeseung

    2016-01-01

    Purpose: The purpose of this study was to evaluate the potential risk factors of type II endoleak and sac growth after endovascular aneurysm repair (EVAR) and the outcomes of secondary interventions. Materials and Methods: Ninety seven patients underwent elective EVAR for infrarenal abdominal aortic aneurysms in two tertiary centers between April 2005 and July 2013. Clinical and imaging parameters were compared among sac growth (>5 mm) and non-growth groups. Risk factors associated with sac growth and persistent type II endoleak were analyzed. The outcomes of reinterventions for persistent type II endoleak were determined. Results: Sac growth was observed in 20 cases (20.6%) and endoleak was found in 90% of them compared to 28.6% (22/77) in the non-growth group (P<0.001). The majority of endoleaks were type II (36/40) and 80.5% were persistent. Sac diameter, neck diameter and number of patent accessory arteries were also statistically significant for sac growth. On multivariate analysis, grade of calcification at the neck, grade of mural thrombus at the inferior mesenteric artery and number of patent accessory arteries were risk factors of persistent type II endoleak. Twenty six reinterventions were done for 16 patients with persistent type II endoleak, with a technical success rate of 88.5%, yet 55.5% showed sac growth regardless of technical success. There were no ruptures during the follow-up period. Conclusion: Sac growth after EVAR was mostly associated with persistent type II endoleak. Secondary interventions using transarterial embolization is partially effective in achieving clinical success. PMID:28042554

  4. Limitations of Endovascular Treatment with Stent-Grafts for Active Mycotic Thoracic Aortic Aneurysm

    SciTech Connect

    Ishida, Masaki; Kato, Noriyuki; Hirano, Tadanori; Shimono, Takatsugu; Yasuda, Fuyuhiko; Tanaka, Kuniyoshi; Yada, Isao; Takeda, Kan

    2002-06-15

    An 81-year-old woman with ruptured mycotic thoracic aortic aneurysm was treated with endovascular placement of stent-grafts fabricated from expanded polytetrafluoroethylene and Z-stents. Although exclusion of the aneurysm was achieved at the end of the procedure, a type I endoleak developed on the following day.Despite emergent surgical resection of the aneurysm and extra-anatomical reconstruction, the patient died 2 days later. Stent-graft repair may not be a suitable method for the treatment of ruptured mycotic aneurysm in the presence of active infection.

  5. Sac Hygroma After Endovascular Abdominal Aortic Aneurysm Repair: Successful Treatment with Endograft Relining

    SciTech Connect

    Ryu, Robert K. Palestrant, Sarah; Ryu, Jessica; Trachtenberg, Jeffrey

    2007-06-15

    Aneurysm sac expansion following endovascular abdominal aortic aneurysm repair (EVAR) is typically associated with endoleaks that can be readily diagnosed on computed tomographic angiography (CTA), ultrasound, or catheter-directed arteriography. Sac hygromas are a cause of sac expansion without apparent endoleak and are presumed to be a result of ultrafiltration of serum manifested by accumulation of fibrinous, gelatinous material within the aneurysm sac following EVAR. Although there are no reported associated ruptures, sac expansion is nevertheless disconcerting and intervention is presumably indicated. We report a case of an expanding aneurysm after EVAR secondary to sac hygroma that was successfully treated with relining of the existing, original endograft.

  6. Endovascular repair of inflammatory abdominal aneurysm: a retrospective analysis of CT follow-up.

    PubMed

    Hechelhammer, Lukas; Wildermuth, Simon; Lachat, Mario L; Pfammatter, Thomas

    2005-05-01

    Retrospective radiologic and clinical midterm follow-up is reported for 10 patients with inflammatory abdominal aortic aneurysm (IAAA) after endovascular aortic aneurysm repair (EVAR). At a mean follow-up of 33 months, regression of the thickness of the perianeurysmal fibrosis (PAF) and decrease of aneurysmal sac diameter was observed in nine patients. Four EVAR-associated complications were observed: periinterventional dissection of femoral artery (n = 1), blue toe syndrome (n = 1), and stent-graft disconnection (n = 2). EVAR is the less invasive method of aneurysm exclusion in patients with IAAA with a comparable evolution of the PAF as reported after open repair.

  7. Recurrence of endovascularly and microsurgically treated intracranial aneurysms-review of the putative role of aneurysm wall biology.

    PubMed

    Marbacher, Serge; Niemelä, Mika; Hernesniemi, Juha; Frösén, Juhana

    2017-08-17

    Although endovascular therapy has been proven safe and has become in many centers the primary method of treatment for intracranial aneurysms, the long-term durability of endovascular embolization remains a concern; at least for some aneurysms despite initial good result. While healing after clipping relies on mechanical occlusion, restoration after endovascular occlusion mainly requires the induction of a biological response. Healing after embolization depends on the growth of new tissue over the thrombus formed by the embolization material, or alternatively, on the organization of thrombus into fibrous tissue. This review highlights the fundamental importance of aneurysm wall biology on the healing process and long-term occlusion after intracranial aneurysm (IA) treatment. It seems likely that the effect of luminal thrombus on the IA wall, as well as the IA wall condition at the time of thrombosis, determine if thrombus organizes into scar tissue (neointima formation by infiltration of cells originating from the IA wall) or if the wall undergoes continuous remodeling, which is primarily destructive (loss of mural cells). In the latter, intraluminal thrombus organization fails and the impaired healing increases the chance of recurrence. Mechanisms underlying IA reopening, the influence of intraluminal thrombosis on the IA wall, and clinical implications of the IA wall condition are discussed in detail, along with how knowledge of IA wall biology can offer new solutions for IA treatment and affect the patient selection for and follow-up after endovascular treatment.

  8. Underutilization of Routine Ultrasound Surveillance after Endovascular Aortic Aneurysm Repair.

    PubMed

    Mell, Matthew W; Garg, Trit; Baker, Laurence C

    2017-10-01

    Since 2009, the Society for Vascular Surgery has advocated annual surveillance imaging with ultrasound (US) after the first postoperative year for uncomplicated endovascular aneurysm repairs (EVARs). We sought to describe diffusion of US into long-term routine surveillance and to estimate potential cost savings among Medicare beneficiaries after EVAR. Using Medicare claims data, we identified patients receiving EVAR from 2002 to 2010 and included only those who did not subsequently have reinterventions, late aneurysm-related complications, or death. We collected all relevant postoperative imaging (computed tomography [CT] and US) through 2011. Patients with follow-up less than 1 year were excluded. We estimated cost savings with increased use of US after the first postoperative year. The cohort comprised 24,615 patients with a mean follow-up of 3.9 ± 2.3 years. Mean number of images decreased from 2.23 in the first postoperative year to 0.31 in the 10th year. Utilization of US at the first postoperative year remained low but increased from 15.2% in 2003 to 28.8% in 2011 (P < 0.001). By the 10th postoperative year, the proportion of patients receiving US increased from 8.2% to 37.8%, while use of CT only remained high but decreased from 60.8% to 42.1%. Mean cost of surveillance imaging was $2,132/CT and $234/US. Performing US in 50-75% of patients beginning 1 year after EVAR would decrease costs by 14-48%/year. This translates to a mean cost savings of $338-$1135 per imaged patient per year, with an estimated savings to Medicare of $155 million to $305 million over 10 years. CT remains the primary modality of surveillance for up to 10 years after EVAR for patients without reinterventions or aneurysm-related complications. Increasing the use of US and decreasing the use of CT would save cost without compromising outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Outcomes Following Limb Crossing in Endovascular Aneurysm Repairs.

    PubMed

    Dattani, Nikesh; Wild, John; Sidloff, David; Fishwick, Guy; Bown, Matthew; Choke, Edward; Sayers, Robert

    2015-01-01

    Crossing the limbs of the stent during endovascular aneurysm repair (EVAR) is often used to aid cannulation of the contralateral limb. This study assessed outcomes following the use of this technique. Retrospective review of crossed (n = 43) and uncrossed (n = 269) EVARs was performed at a tertiary vascular center over 5 years. Primary end points were graft limb occlusion (GLO), endoleak, and sac expansion rates. Indications for limb crossing were also assessed. Two-year GLO (P = .34) and type 1 endoleak (P = .413) rates were similar between groups. Patients undergoing crossed EVAR experienced more type 2 endoleaks (P = .002) at 24 months but no increase in sac expansion rates was observed (P = .275). Thirty-day (P = .57) and late (P = .268) mortalities were similar between groups. The main indication for limb crossing was distal aortic angulation (48.8%). Crossed EVAR does not increase the risk of GLOs or clinically significant endoleaks. Further studies are needed to determine the effect on type 2 endoleak rates. © The Author(s) 2015.

  10. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms.

    PubMed

    Zehm, Sarah; Chemelli, Andreas; Jaschke, Werner; Fraedrich, Gustav; Rantner, Barbara

    2014-06-01

    Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups.

  11. Coagulopathy associated with sac reperfusion for reversing paraplegia after endovascular repair of type II thoracoabdominal aneurysm.

    PubMed

    Lioupis, Christos; Katsanos, Konstantinos; Clough, Rachel; Matharu, Nick; Modarai, Bijan; Carrell, Tom; Taylor, Peter

    2013-11-01

    Sac perfusion may be helpful in preventing or reversing spinal cord injury after endovascular repair of thoracoabdominal aneurysms and it has been used as an adjunct to the standard physiologic measures of sustained hypertension and cerebrospinal fluid drainage. Coagulopathy as a result of endoleak after endovascular aneurysm repair has been reported, and very rare cases of treatment after repair of these endoleaks have been described. We report a 73-year-old man who had endovascular repair of a type II thoracoabdominal aneurysm with a branched stent graft. Sac reperfusion was initiated to manage postoperative paraplegia. The paraplegia partially resolved but severe hemorrhagic complications developed that were attributed to sac perfusion-related hyperfibrinolysis. Discontinuation of sac perfusion resolved the coagulopathy but resulted in paraplegia. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Incidence and predictors of headache relief after endovascular treatment in patients with unruptured intracranial aneurysms.

    PubMed

    Ji, Wenjun; Liu, Aihua; Yang, Xinjian; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue

    2017-02-01

    Objective Patients with unruptured intracranial aneurysms often present with headaches. We retrospectively determined the incidence of headache relief in patients with unruptured intracranial aneurysms after endovascular treatment, with the main goals of preventing aneurysmal haemorrhage and identifying factors associated with headache relief in a cohort study. Methods From a cohort of patients with unruptured intracranial aneurysms who were treated with endovascular coiling and admitted between January 2012 and December 2014, we included 123 patients who had headaches and underwent regular follow-up. The severity of headache was assessed by a quantitative 11-point headache scale for all patients before and after the endovascular treatment. Headache relief was defined as a decrease in the headache score. We determined the incidence and predictors of headache relief using Kaplan-Meier curves and Cox regression analysis. Results Of the 123 patients with a mean follow-up of 14.1 months (range 1-39 months), 69 had headache relief. The overall cumulative incidence of headache relief was 62.3% (95% confidence interval (CI) 54.2%, 69.4%). On multivariate Cox regression analysis, the side of headache ipsilateral to the aneurysm (adjusted hazard ratio 0.540; 95% CI 0.408, 0.715; P < 0.001) and aneurysm size (adjusted hazard ratio 1.753; 95% CI 1.074, 2.863; P = 0.025) were significant predictors of headache relief. Conclusions Endovascular treatment relieved preoperative headaches for most patients with unruptured intracranial aneurysms. The side of headache ipsilateral to the aneurysm and aneurysm size >10 mm were significant predictors of headache relief.

  13. Fibromuscular Dysplasia-Related Renal Artery Stenosis Associated with Aneurysm: Successive Endovascular Therapy

    SciTech Connect

    Serter, Selim Oran, Ismail; Parildar, Mustafa; Memis, Ahmet

    2007-04-15

    Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease. FMD of the renal arteries is one of the leading causes of curable hypertension. The simultaneous occurrence of FMD and renal artery aneurysm has been described previously. In this case, we present a fibrodysplastic lesion and an aneurysm in a renal artery treated with a percutanous transluminal angioplasty and coil embolization.

  14. Fenestrated Endovascular Grafts for the Repair of Juxtarenal Aortic Aneurysms

    PubMed Central

    2009-01-01

    Executive Summary Endovascular repair of abdominal aortic aneurysm (AAA) allows the exclusion of the dilated aneurismal segment of the aorta from the systematic circulation. The procedure requires, however, that the endograft extends to the healthy parts of the aorta above and below the aneurysm, yet the neck of a juxtarenal aortic aneurysm (JRA) is too short for a standard endovascular repair. Fenestrated endovascular aortic repair (f—EVAR) provides a solution to overcome this problem by enabling the continuation of blood flow to the renal and visceral arteries through holes or ‘fenestrations’ in the graft. These fenestrations are designed to match the ostial diameter of the renal and visceral arteries. There are three varieties fenestration, small, large, and scallop, and their location needs to be customized to fit the anatomy of the patient. If the device is not properly designed, if the alignment is inaccurate, or if the catheterization of the visceral arteries is not possible, the procedure may fail. In such cases, conversion to open surgery may become the only option as fenestrated endografts are not retrievable. It is recommended that a stent be placed within each small fenestration to the target artery to prevent shuttering of the artery or occlusion. Many authors have noted an increased risk of vessel occlusion in unstented fenestrations and scallops. Once placed in a patient, life-long follow-up at regular intervals is necessary to ensure the graft remains in its intended location, and that the components have adequate overlap. Should the need arise, routine follow-up allows the performance of timely and appropriate intervention through detection of events that could impact the long-term outcomes. Alternative Technology The technique of fenestrated endovascular grafting is still in evolution and few studies have been with published mid-term outcome data. As the technique become more common in vascular surgery practices, it will be important to

  15. Endovascular Abdominal Aortic Aneurysm Repair in the Presence of a Kidney Transplant: Therapeutic Considerations

    SciTech Connect

    Karkos, Christos D. McMahon, Greg; Fishwick, Guy; Lambert, Kelly; Bagga, Ajay; McCarthy, Mark J.

    2006-04-15

    Abdominal aortic aneurysm (AAA) repair in the presence of a kidney transplant can be extremely challenging, as it carries significant risks of renal ischemia. Endovascular repair is an attractive option, as it can be performed with little or no impairment of renal arterial flow. We describe the endovascular management of a recurrent AAA in a patient with a functioning renal transplant using a custom-made aorto-uni-iliac device. We discuss the planning and the potential problems of the technique.

  16. A combined endovascular and open ''reverse hybrid'' technique for repair of complex juxtarenal inflammatory aortic aneurysms.

    PubMed

    Rigberg, David; Jimenez, Juan Carlos; Lawrence, Peter; Gelabert, Hugh

    2009-01-01

    Inflammatory abdominal aortic aneurysms (IAAA) can present significant challenges to surgeons, especially in the juxtarenal location where they may not be amenable to endovascular repair. The dense, inflammatory component of these lesions can encase adjacent structures including the duodenum, ureters, and inferior vena cava putting them at risk for injury during open exposure. We report a novel ''reverse hybrid'' technique using a combined endovascular and open approach for repair of large, juxtarenal IAAA's.

  17. Assessment of endovascular coil configuration for embolization of intracranial aneurysms using computational fluid dynamics.

    PubMed

    Ohshima, Tomotaka; Miyachi, Shigeru; Takahashi, Ichiro; Ishii, Katsuya

    2015-08-01

    Endovascular coil embolization of arterial aneurysms is often complicated by reduced blood flow to branching arteries. To determine the optimal coil configuration for safe embolization of endovascular aneurysms without compromising blood flow in branching arteries. A 3-dimensional voxel model, built based on an unruptured vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm, predicted to show impairment of flow in the PICA during endovascular coil embolization (Case 0). Six different models of final coil configuration were generated and applied to this aneurysm. Case 1 was a round coil mass. Case 2 was designed with a stent assist. Cases 3, and 4 were designed with a neck remnant and Cases 5 and 6 incorporated a balloon neck remodeling technique. Computational fluid dynamics was used to analyze the flow in the PICA in each model. The average outflow to the PICA was highest in Case 0 and lowest in Case 2 (in descending order, Case 0, 5, 4, 6, 1, 3, and 2). There was better preservation of outflow to the PICA in the balloon neck remodeling models than in the neck remnant models. In a model of endovascular coil embolization, we found considerable differences in outflow to the branching artery with small changes in coil configuration. Careful preoperative planning is important to minimize the risk of thromboembolic events during and after endovascular coil embolization.

  18. Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery.

    PubMed

    Tolva, Valerio Stefano; Bianchi, Paolo Guy; Cireni, Lea Valeria; Lombardo, Alma; Keller, Guido Carlo; Parati, Gianfranco; Casana, Renato Maria

    2012-01-01

    Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions. A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels. Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results.

  19. Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery

    PubMed Central

    Tolva, Valerio Stefano; Bianchi, Paolo Guy; Cireni, Lea Valeria; Lombardo, Alma; Keller, Guido Carlo; Parati, Gianfranco; Casana, Renato Maria

    2012-01-01

    Purpose Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions. Case report A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels. Conclusion Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results. PMID:22866014

  20. Endovascular treatment of a small infrarenal abdominal aortic aneurysm causing duodenal obstruction: Case report and literature review.

    PubMed

    Esposito, Andrea; Menna, Danilo; Mansour, Wassim; Sirignano, Pasqualino; Capoccia, Laura; Speziale, Francesco

    2015-06-01

    Duodenal obstruction caused by abdominal aortic aneurysm was first described by Osler in 1905 and is named "aortoduodenal syndrome." This condition has always been treated by open surgical repair. We report the first case of aortoduodenal syndrome successfully treated by endovascular aneurysm repair. A 74-year-old male patient referred to our hospital complaining postprandial vomit, reporting a consistent weight loss in the latest weeks. Enhanced computed tomography scans showed a small saccular abdominal aortic aneurysm compressing duodenum and inferior vena cava without any other evident pathological finding. As the patient underwent a successful endovascular treatment of the abdominal aortic aneurysm, symptoms immediately resolved so that he started back to feed and progressively gained body weight. Despite aortoduodenal syndrome is generally caused by large abdominal aortic aneurysm, this condition has to be suspected also in case of small abdominal aortic aneurysm. Differently from what has been reported in literature, endovascular aneurysm repair could be effective in the treatment of aortoduodenal syndrome.

  1. Hybrid Decision Support System for Endovascular Aortic Aneurysm Repair Follow-Up

    NASA Astrophysics Data System (ADS)

    Legarreta, Jon Haitz; Boto, Fernando; Macía, Iván; Maiora, Josu; García, Guillermo; Paloc, Céline; Graña, Manuel; de Blas, Mariano

    An Abdominal Aortic Aneurysm is an abnormal widening of the aortic vessel at abdominal level, and is usually diagnosed on the basis of radiological images. One of the techniques for Abdominal Aortic Aneurysm repair is Endovascular Repair. The long-term outcome of this surgery is usually difficult to predict in the absence of clearly visible signs, such as leaks, in the images. In this paper, we present a hybrid system that combines data extracted from radiological images and data extracted from the Electronic Patient Record in order to assess the evolution of the aneurysm after the intervention. The results show that the system proposed by this approach yields valuable qualitative and quantitative information for follow-up of Abdominal Aortic Aneurysm patients after Endovascular Repair.

  2. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

    PubMed

    Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario

    2010-01-01

    The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

  3. Sac enlargement due to seroma after endovascular abdominal aortic aneurysm repair with the Endologix PowerLink device.

    PubMed

    Nano, Giovanni; Dalainas, Ilias; Bianchi, Paolo G; Gotti, Riccardo; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    A patient who had undergone endovascular repair of an abdominal aortic aneurysm with the Endologix PowerLink bifurcated system presented with delayed aortic aneurysm enlargement due to assumed endotension. He was treated with aortic sac evacuation and wrapping of the endograft. This is the first report of endotension and aneurysm sac enlargement after implantation of the PowerLink endograft.

  4. [Endovascular treatment of the renal artery aneurysm with stent and coils].

    PubMed

    Juszkat, Robert; Zarzecka, Anna; Stanisić, Michał; Majewski, Wacław

    2012-01-01

    Aneurysms of the renal artery are very rare and its incidence is estimated at 0.01% of population. A 50-year-old male was admitted to the Department of General and Vascular Surgery due to incidentally diagnosed aneurysm of the left renal artery. Due to wide neck of the aneurysm, a two-step procedure was planned. First, an intracranial stent was implanted into the left renal artery. Second, after 3 months, platinum coils were deposed in the aneurysm sac through the stent struts. Aneurysmal sac was totally occluded. Periprocedural course was uneventful. The endovascular embolization with the use of stent and detachable coils is a safe method of treatment of wide-necked renal artery aneurysms with preserving parent vessel patency.

  5. Endovascular Repair of Internal Mammary Artery Aneurysms in Two Sisters with SMAD3 Mutation.

    PubMed

    Nevidomskyte, Daiva; Shalhub, Sherene; Aldea, Gabriel S; Byers, Peter H; Schwarze, Ulrike; Murray, Mitzi L; Starnes, Benjamin

    2017-03-07

    True aneurysms of the internal mammary artery are rare and have been described in association with vasculitis or connective tissue disorders. Herein we describe two cases of familial internal mammary artery aneurysms in two sisters with SMAD3 mutation. The older sister presented at the age of 54 with an incidental diagnosis of a multilobed right internal mammary artery aneurysm (IMA) and the younger sister presented several years earlier with a ruptured left IMA aneurysm at the age of 49. Both sisters had Debakey type I aortic dissections prior to the IMA aneurysm presentation. To our knowledge this is the first time IMA aneurysms has been described in siblings with SMAD3 mutation. In our experience endovascular repair is a feasible and safe treatment option. An assessment of the entire arterial tree is recommended in patients diagnosed with SMAD3 mutations.

  6. Endovascular treatment of distal middle cerebral artery aneurysms: Report of eight cases and literature review

    PubMed Central

    Lv, Nan; Zhou, Yu; Yang, Pengfei; Li, Qiang; Zhao, Rui; Fang, Yibin; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin

    2016-01-01

    Background Endovascular treatment is an alternative choice for the treatment of distal middle cerebral artery (dMCA) aneurysm, in addition to open surgery; but is still seldom considered. We performed this retrospective study to evaluate the outcome of dMCA in patients. Methods During a period of 10 years, we were able to identify seven patients with a total of eight dMCA aneurysms that were treated endovascularly. They were five men and two women, with a mean age of 36.1 years. All of the aneurysms, including five infectious and three dissecting ones, were treated for the aneurysm and its parent artery’s occlusion, using coils and/or glue. Results The clinical follow-up (9–96 m, mean 36.8 m) showed that they all improved over baseline; except for one patient in whom a mild right hemiparesis remained, after the hematoma evacuation. Angiographic follow-up (7–24 m; mean: 14.6 m) showed that all of them were stable and without the need for recanalization. Conclusions Our data indicated that endovascular treatment is a safe and effective alternative for the treatment of dMCA aneurysms, and should be considered when treating these aneurysms. PMID:26637241

  7. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.

    PubMed

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.

  8. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    PubMed Central

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  9. Endovascular vs open repair for ruptured abdominal aortic aneurysm

    PubMed Central

    Nedeau, April E.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Hsu, Richard; Sachs, Teviah; Siracuse, Jeffrey J.; Schermerhorn, Mark L.

    2014-01-01

    Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care. PMID:22626871

  10. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.

    PubMed

    Lederle, Frank A; Freischlag, Julie A; Kyriakides, Tassos C; Matsumura, Jon S; Padberg, Frank T; Kohler, Ted R; Kougias, Panagiotis; Jean-Claude, Jessie M; Cikrit, Dolores F; Swanson, Kathleen M

    2012-11-22

    Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain. We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2). Patients were selected from 42 Veterans Affairs medical centers and were 49 years of age or older at the time of registration. More than 95% of the patients underwent the assigned repair. For the primary outcome of all-cause mortality, 146 deaths occurred in each group (hazard ratio with endovascular repair versus open repair, 0.97; 95% confidence interval [CI], 0.77 to 1.22; P=0.81). The previously reported reduction in perioperative mortality with endovascular repair was sustained at 2 years (hazard ratio, 0.63; 95% CI, 0.40 to 0.98; P=0.04) and at 3 years (hazard ratio, 0.72; 95% CI, 0.51 to 1.00; P=0.05) but not thereafter. There were 10 aneurysm-related deaths in the endovascular-repair group (2.3%) versus 16 in the open-repair group (3.7%) (P=0.22). Six aneurysm ruptures were confirmed in the endovascular-repair group versus none in the open-repair group (P=0.03). A significant interaction was observed between age and type of treatment (P=0.006); survival was increased among patients under 70 years of age in the endovascular-repair group but tended to be better among those 70 years of age or older in the open-repair group. Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected. (Funded by the Department of Veterans Affairs Office of

  11. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia

    PubMed Central

    Kfoury, Elias; Almanfi, Abdelkader; Dougherty, Kathryn G.

    2016-01-01

    Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature. PMID:27303239

  12. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    SciTech Connect

    Okada, Takuya Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-15

    Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  13. Intra-arterial and Intravenous Tirofiban Infusion for Thromboembolism during Endovascular Coil Embolization of Cerebral Aneurysm.

    PubMed

    Kim, Sang Heum; Kim, Tae Gon; Kong, Min Ho

    2017-09-01

    Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading (5 μg/kg, respectively) for 3-5 minutes followed by IV maintenance (0.08 μg/kg/min) for approximately 4-24 hours. In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

  14. Endovascular Treatment of a Ruptured Para-Anastomotic Aneurysm of the Abdominal Aorta

    SciTech Connect

    Sfyroeras, Giorgos S.; Lioupis, Christos Bessias, Nikolaos; Maras, Dimitris; Pomoni, Maria; Andrikopoulos, Vassilios

    2008-07-15

    We report a case of a ruptured para-anastomotic aortic aneurysm treated with implantation of a bifurcated stent-graft. A 72-year-old patient, who had undergone aortobifemoral bypass for aortoiliac occlusive disease 16 years ago, presented with a ruptured para-anastomotic aortic aneurysm. A bifurcated stent-graft was successfully deployed into the old bifurcated graft. This is the first report of a bifurcated stent-graft being placed through an 'end-to-side' anastomosed old aortobifemoral graft. Endovascular treatment of ruptured para-anastomotic aortic aneurysms can be accomplished successfully, avoiding open surgery which is associated with increased mortality and morbidity.

  15. Surgical and endovascular treatment of visceral arteries aneurysms: single-institution experience.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    Through a retrospective single-Institution study we report our experience on the treatment of the visceral arteries aneurysms, surgical or endovascular. Between February 1993 and February 2003, 17 patients were admitted to our Institution for treatment of an aneurysm of a visceral artery. In the pre-endovascular period for our Institution (1993-1998), 9 patients have been treated surgically. In the second period (1998-2003), 4 patients were treated surgically; and 4 with an endovascular procedure. Only 1 patient died in the operating room because of the advanced hypovolemic shock (rupture pancreatoduodenal artery aneurysm) that was admitted to the Institution. She was one of the surgically treated patients of the second period. No other complications occurred in the other patients. The endovascular procedures had favorable outcome. Actually, the treatment of choice in our Department is interventistic, preferring endovascular treatment when the clinical and anatomo-morphological conditions are favorable. When the morphologic conditions are not favorable, the surgical reconstruction should respect as much as possible the anatomic location of the lesion.

  16. Emergency endovascular treatment of a ruptured thoracic aneurysm discovered as a back pulsatile mass.

    PubMed

    Collart, Frédéric; Kerbaul, Francois; Jop, Bertrand; Magnan, Pierre-Edouard; Bartoli, Jean-Michel

    2005-07-20

    We report a case of a 65-year-old patient admitted in emergency for a sudden chest pain associated with a pulsatile mass of the back. The CT scan showed a ruptured dissecting aneurysm involving the chest wall. The patient was treated in emergency with an endovascular-covered prosthesis with a favorable outcome.

  17. A 5-year evaluation using the talent endovascular graft for endovascular aneurysm repair in short aortic necks.

    PubMed

    Jim, Jeffrey; Sanchez, Luis A; Rubin, Brian G; Criado, Frank J; Fajardo, Andres; Geraghty, Patrick J; Sicard, Gregorio A

    2010-10-01

    Although endovascular aneurysm repair has been shown to be an effective way to treat abdominal aortic aneurysm (AAA), certain anatomic characteristics such as a short aortic neck, limit its applicability. Initially, commercially available devices were approved only for the treatment of AAA with an aortic neck length ≥ 15 mm. The purpose of this study was to evaluate the outcomes of the recently approved Talent endograft for AAAs with a short aortic neck length (10-15 mm). Data were obtained from the prospective, nonrandomized, multicenter Talent enhanced Low Profile Stent Graft System trial which enrolled patients between February 2002 and April 2003. A total of 154 patients with adequate preoperative imaging were identified for this study. Subgroup analyses were performed for AAA with 10-15 mm aortic neck and those with >15 mm neck. Safety and effectiveness endpoints were evaluated at 30 days, 1 year, and 5 years postprocedure. Patients treated with aortic neck lengths of 10-15 mm (n = 35) and those with >15 mm (n = 102) had similar age, gender, and risk factor profile. Both groups had similar preoperative aneurysm morphology in terms of maximum aneurysm size, degree of neck angulation, or proximal neck diameter. There were no statistically significant differences in freedom from major adverse events and mortality rates at 30 and 365 days. Similarly, there was no difference in the effectiveness endpoints at 12 months. At 5 years, there was no difference in migration rate, endoleaks, or change in aneurysm diameter from baseline. In addition, there is no difference in freedom from aneurysm-related mortality (94% vs. 99%). AAAs with short aortic necks (10-15 mm) and otherwise suitable anatomy for endovascular repair can be safely and effectively treated with the Talent endograft with excellent 1 and 5 year outcomes. Copyright © 2010. Published by Elsevier Inc.

  18. Endovascular treatment of recurrent intracranial aneurysms following previous microsurgical clipping with the Pipeline Embolization Device.

    PubMed

    Ding, Dale; Starke, Robert M; Evans, Avery J; Jensen, Mary E; Liu, Kenneth C

    2014-07-01

    The treatment of intracranial aneurysms with microsurgical clipping is associated with a very low rate of recurrence. However, in cases of aneurysm recurrence after previous clipping, microsurgical dissection due to adhesions and fibrosis may be challenging, and it may be difficult to safely occlude the recurrent lesion without the risk of significant morbidity. Flow-diverting stents have drastically changed the landscape of endovascular neurosurgery. We present two patients with large, recurrent supraclinoid internal carotid artery (ICA) aneurysms which were previously clipped 17 and 23 years ago at outside institutions. Both recurrent lesions were treated with the Pipeline Embolization Device (PED; ev3 Endovascular, Irvine, CA, USA) without radiographic or clinical complications. In the first patient, the 15 mm aneurysm significantly decreased in size at 6 month angiographic follow-up. The 21 mm aneurysm in the second patient was completely occluded 7 months following PED treatment. The moderate degree of in-stent stenosis present on initial follow-up imaging resolved on angiography 11 months post-treatment. The management of recurrent aneurysms after clipping is sparsely reported in the literature due to its infrequent occurrence. In carefully selected cases, flow-diverting stents may be used for complex aneurysms of the distal ICA, even for those which have recurred following microsurgical clipping.

  19. Endovascular Exclusion of Abdominal Aortic Aneurysms: Initial Experience with Stent-Grafts in Cardiology Practice

    PubMed Central

    Howell, Marcus H.; Zaqqa, Munir; Villareal, Rollo P.; Strickman, Neil E.; Krajcer, Zvonimir

    2000-01-01

    The use of an endovascular stent-graft prosthesis for the treatment of infrarenal abdominal aortic aneurysms is receiving increasing attention as an option that may avoid the significant morbidity and mortality associated with open surgical treatment. We studied the clinical effectiveness of stent-grafts in patients with infrarenal abdominal aortic aneurysms. Between October 1995 and May 1998, 33 patients underwent infrarenal abdominal aortic aneurysm exclusion with a homemade polytetrafluoroethylene-covered stent, and between November 1998 and September 1999, 56 patients underwent abdominal aortic aneurysm exclusion with the Medtronic AneuRx stent-graft. Overall, these patients represented a high-risk surgical group. The technical success rate was 100% in both groups. No patient required immediate conversion to open repair. With the polytetrafluoroethy-lene-covered stent, the primary success rate was 33%, and the secondary success rate was 76%. In the AneuRx group, the primary success rate was 82.8%, and the secondary success rate was 85.3% at 6 months. There was no procedural or 1-month mortality or major morbidity in either group. By showing that infrarenal abdominal aortic aneurysms can be treated safely and successfully with an endoluminal stent-graft, our early results provide additional support for the endovascular treatment of abdominal aortic aneurysms. Further follow-up studies will determine the long-term ability of such treatment to prevent aneurysmal rupture and death. PMID:10928501

  20. Management and Outcomes of Isolated Renal Artery Aneurysms in the Endovascular Era

    PubMed Central

    Buck, Dominique B; Curran, Thomas; McCallum, John C; Darling, Jeremy; Mamtani, Rishi; van Herwaarden, Joost A; Moll, Frans L; Schermerhorn, Marc L

    2015-01-01

    Objective Isolated renal artery aneurysms are rare and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on patient selection and outcomes of renal artery aneurysms. Methods We identified all patients undergoing open or endovascular repair of isolated renal artery aneurysms in the Nationwide Inpatient Sample (NIS) from 1988 to 2011 for epidemiologic analysis. Elective cases were selected from the period of 2000 to 2011, to create comparable cohorts for outcome comparison. We identified all patients with a primary diagnosis of renal artery aneurysms undergoing open surgery (reconstruction or nephrectomy) or endovascular repair (coil or stent). Patients with a concomitant aortic aneurysms or dissections were excluded. We evaluated patient characteristics, management, and in-hospital outcomes for open and endovascular repair, and we examined changes in management and outcomes over time. Results We identified 6,234 renal artery aneurysm repairs between 1988 and 2011. Total repairs increased after the introduction of endovascular repair (8.4 in 1988 to 13.8 in 2011 per 10million(M) US population, P=0.03). Endovascular repair increased from 0 in 1988 to 6.4 in 2011 per 10M US population (P<.0001). However, there was no concomitant decrease in open surgery (5.5 in 1988 to 7.4 in 2011 per 10M US population, P=0.28). From 2000–2011 there were 1,627 open and 1,082 endovascular elective repairs. Patients undergoing endovascular repair were more likely to have a history of coronary artery disease (18% vs. 11%, P<0.001), prior myocardial infarction (5.2% vs. 1.8%, P<0.001) and renal failure (7.7% vs. 3.3%, P<0.001). In-hospital mortality was 1.8% for endovascular and 0.9% for open reconstruction (P=0.037), and 5.4% for nephrectomy (P<.001 compared to all revascularization). Complication rates were 12.4% for open repair vs 10.5% for endovascular repair (P=0.134), including more cardiac (2.2% vs. 0.6%, P=0

  1. Mid-term results after endovascular repair of abdominal aortic aneurysms: a four-year experience.

    PubMed

    Dalainas, I; Nano, G; Casana, R; Tealdi Dg, D g

    2004-03-01

    The purpose of this retrospective, single-institution study is to describe a 4-year experience of examining early and late clinical outcomes after endovascular repair of abdominal aortic aneurysm (AAA). Between October 1998 and January 2003, 455 patients were submitted for AAA treatment, of whom 269 underwent open repair and 186 were treated with an endovascular procedure. All endovascular-treated patients underwent preoperative arteriography, contrast enhanced CT scanning or spiral-CT to define the morphological characteristics of the aneurysm, including precise diameter and length measurements. Technical success was achieved in 182 (98%) of the endovascular procedures, as intraoperative conversions to open repair and/or aborted procedures occurred in four patients. The perioperative (30-day) mortality rate was 1% (two patients). During the follow-up period (9-60 months) CT, duplex ultrasound scanning and plain abdominal X-ray evaluation were performed at 3, 6, 12 months, and annually thereafter. Type I endoleak occurred in 12 patients (6.6%), required a further endovascular procedure (11) or late conversion to open repair (1). Type II endoleak occurred in five patients (3%). In our clinical experience the endovascular repair of AAA is a safe and effective technique with good mid-term results in patients at standard and high risk.

  2. Infrarenal endovascular aneurysm repair: New developments and decision making in 2016.

    PubMed

    Smeds, Matthew R; Charlton-Ouw, Kristofer M

    2016-03-01

    New developments in infrarenal abdominal aortic aneurysm stent-graft devices have made more patients eligible for endovascular aneurysm repair (EVAR). Recent US Food and Drug Administration approval for fenestrated endograft repair and impending approval for iliac branch devices extend the proximal and distal landing zones. Better deployment systems allow for partial deployment of endografts to facilitate repositioning, and more flexible designs allow for treatment of angulated infrarenal aneurysm necks and tortuous iliac arteries. New iterations of endografts have smaller delivery catheter diameters, which facilitate traversal of smaller access vessels. Long-term outcomes data are still accumulating and it remains to be seen whether EVAR for this expanded-indication abdominal aortic aneurysms anatomy has the same durability as standard EVAR. More options for repair also mean vascular surgeons must select the best EVAR device based on each patient's abdominal aortic aneurysm anatomy.

  3. Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms-a single center experience.

    PubMed

    Lescher, Stephanie; du Mesnil de Rochemont, Richard; Berkefeld, Joachim

    2016-04-01

    The introduction of the Woven Endobridge (WEB) device increases the feasibility of endovascular treatment of wide-neck bifurcation aneurysms with limitations given by currently available sizes and shapes of the device. Parallel to other studies, we used the new device for selected patients who were no optimal candidates for established techniques like neurosurgical clipping or endovascular coiling. We aimed to report the angiographic and clinical results of WEB implantations or combinations between WEB and coiling or intracranial stents. We reviewed the records of n = 23 interventions in 22 patients with unruptured wide-neck aneurysms (UIA) who were assigned for aneurysm treatment with the use of the WEB or adjunctive techniques. Interventional procedures and clinical and angiographic outcomes are reported for the periprocedural phase and in mid-term FU. Of the included 22 patients, six patients needed additional coiling, intracranial stenting, or implantation of a flow diverter. WEB implantation was technically feasible in 22 out of the 23 interventions. Follow-up angiographic imaging proved total or subtotal occlusion of the aneurysm in 19 of 22 cases. Two minor recurrences remained stable during a period of 15 months. One patient with a partially thrombosed giant MCA aneurysm had a major recurrence and was retreated with a second WEB in combination with coiling. Despite of unfavorable anatomic conditions, broad-based and large UIA endovascular treatment with the WEB and adjunctive techniques was feasible with a low risk of complications and promising occlusion rates in mid-term follow-up.

  4. Accuracy of Computational Cerebral Aneurysm Hemodynamics Using Patient-Specific Endovascular Measurements

    NASA Astrophysics Data System (ADS)

    McGah, Patrick; Levitt, Michael; Barbour, Michael; Mourad, Pierre; Kim, Louis; Aliseda, Alberto

    2013-11-01

    We study the hemodynamic conditions in patients with cerebral aneurysms through endovascular measurements and computational fluid dynamics. Ten unruptured cerebral aneurysms were clinically assessed by three dimensional rotational angiography and an endovascular guidewire with dual Doppler ultrasound transducer and piezoresistive pressure sensor at multiple peri-aneurysmal locations. These measurements are used to define boundary conditions for flow simulations at and near the aneurysms. The additional in vivo measurements, which were not prescribed in the simulation, are used to assess the accuracy of the simulated flow velocity and pressure. We also performed simulations with stereotypical literature-derived boundary conditions. Simulated velocities using patient-specific boundary conditions showed good agreement with the guidewire measurements, with no systematic bias and a random scatter of about 25%. Simulated velocities using the literature-derived values showed a systematic over-prediction in velocity by 30% with a random scatter of about 40%. Computational hemodynamics using endovascularly-derived patient-specific boundary conditions have the potential to improve treatment predictions as they provide more accurate and precise results of the aneurysmal hemodynamics. Supported by an R03 grant from NIH/NINDS

  5. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm - Adequate Access is Essential for Success - Case Report.

    PubMed

    Tkalčić, Lovro; Budiselić, Berislav; Kovačević, Miljenko; Knežević, Siniša; Kovačić, Slavica; Miletić, Damir; Tomulić, Vjekoslav; Kuhelj, Dimitrij

    2017-01-01

    An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother's autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Self-expandable, covered stent (Bard, Fluency(®)) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX(®)) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Endovascular management of SMAA proved to be safe and efficient. The "access from above" is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications.

  6. Aneurysm clipping after endovascular treatment with coils: a report of 13 cases.

    PubMed

    Klein, Olivier; Colnat-Coulbois, Sophie; Civit, Thierry; Auque, Jean; Bracard, Serge; Pinelli, Catherine; Marchal, Jean-Claude

    2008-10-01

    In 1996, Civit et al. (Neurosurgery, 38:955-961, 1996) reported a series of eight patients whose aneurysms were clipped after previous embolization with coils. This paper highlighted the safety of this surgery in second line, with a low complication rate and a favorable outcome. The two major surgical indications were either after deliberate partial occlusion of the aneurysm (N=3) or partial occlusion after endovascular treatment (N=3). Reviewing 13 additional patients from 1996 to June 2005, the authors compared the surgical indications and focused on the technical problems of clipping after coiling. Thirteen patients (men=6, women=7) with aneurysm clipping following one or more endovascular embolizations have been operated on since 1996. The patients' files were reviewed retrospectively by both a senior consultant neurosurgeon and a neuroradiologist. Demographic data included sex, age at admission, relevant medical history, initial endosaccular treatment and its quality (partial or complete effectiveness), the rationale for surgery, and the complications arising from the different treatments. In addition to the patient's clinical follow-up, angiograms were performed soon after the surgical procedure, 3 months, 1 year, and 5 years after the coiling, respectively. None of the initial endovascular treatments was complete. Surgical indication was related firstly to anatomical particularities of the aneurysm (width of the neck, N=5; arterial branches from the aneurysm, N=4; no individualized neck in a small aneurysm, N=1); secondly to a shift of the coils with delayed aneurysm regrowth and repermeabilization, N=4; and thirdly to rebleeding, N=3. All the patients who were operated on underwent complete surgical exclusion of their aneurysm (controlled by angiogram). Twelve out of 13 patients recovered satisfactorily (92.3%), attaining the same neurological state they presented prior to surgery. One patient died after the operation. He had already been in a serious

  7. [Endovascular coiling of a «true» posterior communicating artery aneurysm].

    PubMed

    Almeida-Pérez, Rafael; Espinosa-García, Héctor; Alcalá-Cerra, Gabriel; de la Rosa-Manjarréz, Ginna; Orozco-Gómez, Fernando

    2014-01-01

    True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  8. Endovascular treatment of hepatic artery aneurysm in a patient with Ehlers-Danlos syndrome. Case report.

    PubMed

    Casana, R; Nano, G; Dalainas, I; Tealdi, D G

    2004-09-01

    Ehlers-Danlos syndrome (EDS) is a rare, variably inherited disorder affecting connective tissue. Patients with EDS often develop aneurysms of the thoracic and abdominal aorta as well as the visceral arteries. We report our experience with an elective endovascular exclusion of an hepatic artery aneurysm in a 26-year-old female patient with EDS type IV. A balloon-expandable 4x26 mm stent-graft was placed in the common hepatic artery, excluding the aneurysm. The follow-up at the 2, 6 and 18 months showed the patency of the common hepatic artery, the absence of endo-leak and the right location of the stent-graft. In EDS patients, the endovascular treatment could be preferable to open surgery because of the minimum trauma.

  9. Standardized off-the-shelf components for multibranched endovascular repair of thoracoabdominal aortic aneurysms.

    PubMed

    Chuter, Tim; Greenberg, Roy K

    2011-09-01

    Endovascular techniques have been slow to assume a primary role in the management of thoracoabdominal aortic aneurysms (TAAAs) because of the high cost of multiple components, regulatory challenges, manufacturing delays, and the complexity of multibranched stent graft insertion. Standardized off-the-shelf stent grafts have the potential to lower all these barriers to the widespread application of multibranched endovascular technology. Despite the desire for a single design to accommodate all variations of thoracoabdominal aneurysms, different approaches are likely required for patients with extensive aneurysmal disease compared with disease that is more localized to the infradiaphragmatic region or that which does not extend below the renals. This article summarizes the basic concepts and stent graft designs for repair of TAAA using off-the-shelf fenestrated and branched endografts.

  10. Endovascular Repair of a Ruptured Mycotic Aneurysm of the Common Iliac Artery

    SciTech Connect

    Mofidi, R. Bhat, R.; Nagy, J.; Griffiths, G. D.; Chakraverty, S.

    2007-09-15

    This report describes the case of a ruptured mycotic aneurysm of the left common iliac artery, successfully treated with endovascular stent-grafting. A 64-year-old woman underwent diagnostic coronary angiography complicated by an infected hematoma of the left groin. Seven days later, she developed methicillin-resistant Staphylococcus aureus septicemia and CT scan evidence of perivascular inflammation around the left common iliac artery. This was followed by rupture of a mycotic aneurysm of the left common iliac artery. The lesion was successfully treated with a stent-graft and prolonged antibiotic therapy, and the patient remains free of infection 10 months later. Accumulating evidence suggests that endovascular repair can be used safely for the repair of ruptured infected aneurysms.

  11. Distal anterior cerebral artery aneurysms: endovascular or surgical treatment? A case report.

    PubMed

    Saponiero, R; Toriello, A; Locatelli, G; Pugliese, N D; Napoli, A N; Napoli, M; Siani, A; Cuomo, G; Panza, M P; Narciso, N; Posteraro, L

    2008-04-07

    Cerebral aneurysms are occasionally associated with anomalies of the cerebral arteries. Most reports on anomalies of the anterior cerebral artery have been concerned with hypoplasia, fenestration and the infra-optic course of the A1, variant A1 perforators or Heubner's artery, multi-channeled anterior communicating artery, and azygos anterior cerebral artery. Distal anterior cerebral artery (ACA) aneurysms are known to have a poor clinical course and prognosis compared to other supratentorial aneurysms. The presence of the unpaired, distal, postcommunicating (A2) segment of the ACA is very rare in adults. We describe a patient with a ruptured aneurysm arising from the proximal end of the azygos ACA, first surgically treated with clipping and then with endovascular coiling. A 37-year-old woman at 34 weeks' gestation was transferred to our emergency room with sudden onset of severe headache and vomiting. Computed tomography (CT) revealed subarachnoid hemorrhage in the basal cisterna and the sylvian and interhemispheric fissures. Cerebral angiography showed an azygos ACA, a saccular aneurysm at the junction of the azygos ACA and the right A1 segment. A right fronto-temporal craniotomy was performed in the day of admission, and the neck of the aneurysm was clipped. One year later, an angiographic control examination revealed a regrowth of the aneurysm. The patient underwent endovascular treatment with coiling. Aneurysms of the azygos ACA are rare and their pathogenesis and course are still a matter of discussion. Developmental abnormalities or dynamic vessel wall stresses can explain the high incidence of aneurysms in these cases. The association of a rare anatomical variant with an aneurysm in the same location may suggest an embryogenesis alteration in the Willis circulation.

  12. [Superior mesenteric artery aneurysm treated with endovascular stentgraft implantation].

    PubMed

    Juszkat, Robert; Zarzecka, Anna; Winckiewicz, Marek; Majewski, Wacław

    2012-01-01

    Aneurysms of the superior mesenteric are very rare and comprises 5.5% of all visceral artery aneurysms. A 60-year-old male was admitted to the General and Vascular Surgery Department due to the superior mesenteric artery (SMA) aneurysm, diagnosed in angio CT. Due to wide neck of the aneurysm and its localization in the mid-die segment of the SMA, a decision to implant a stentgraft was made. After surgical exposure of the right common femoral artery, a stentgraft Viabahn was implanted into the SMA. Control angiography revealed total aneurysm exclusion and patent SMA. Periprocedural course was uneventful. Follow-up CT scan 2 year after the procedure revealed no contrast filling of the aneurysm and patent SMA. A stentgraft implantation is a effective method of treatment of the wide-necked SMA aneurysms.

  13. MR spectroscopy in patients after surgical clipping and endovascular embolisation of intracranial aneurysms

    PubMed Central

    Tarasów, Eugeniusz; Kochanowicz, Jan; Brzozowska, Joanna; Mariak, Zenon; Walecki, Jerzy

    2010-01-01

    Summary Background: In MR spectroscopy, we evaluated cerebral metabolic changes in patients 2–4 years after clipping or endovascular therapy of intracranial aneurysms. Material/Metodhs: A prospective study was conducted in 36 patients after SAH, treated surgically (n=23) or by endovascular embolisation (n=13). Control group consisted of 20 healthy volunteers. The clinical evaluation was based on the Glasgow Coma Scale, Hunt and Hess grade, and Glasgow Outcome Scale. MR spectroscopy was performed with 1.5T system with PRESS sequence, at echo time of 35 ms, in frontal lobes unchanged in MR examination. Ratios of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI) and glutamine/glutamate complex (Glx) to creatine were assessed. Results: Only a slight, statistically insignificant reduction of NAA/Cr and an insignificant increase of mI/Cr were noted; other metabolite ratios were close to the ones in the control group. Similar results were obtained in patients after surgical clipping and after endovascular therapy. Only in patients with aneurysms of anterior communicating artery complex (AcoA), the NAA/Cr ratio showed a significant reduction as compared to that of non-AcoA patients and of the control group. No significant changes of metabolite ratios were found in patients with internal carotid artery (ICA) and middle cerebral artery (MCA) aneurysms, with regard to aneurysm lateralisation. Conclusions: Surgical clipping and endovascular embolisation of ICA, MCA and posterior circulatory aneurysms do not induce changes in metabolite concentration in frontal lobes assessed in MR spectroscopy. In patients with AcoA aneurysms, 2–4 years after obliteration, there were found persistent metabolic changes in unchanged brain tissue of the frontal lobes, corresponding to neuronal damage (dysfunction). PMID:22802800

  14. Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms.

    PubMed

    Jahromi, Babak S; Mocco, J; Bang, Jee A; Gologorsky, Yakov; Siddiqui, Adnan H; Horowitz, Michael B; Hopkins, L Nelson; Levy, Elad I

    2008-10-01

    Giant (>or=25 mm) intracranial aneurysms (IA) have an extremely poor natural history and continue to confound modern techniques for management. Currently, there is a dearth of large series examining endovascular treatment of giant IAs only. We reviewed long-term clinical and radiological outcome from a series of 39 consecutive giant IAs treated with endovascular repair in 38 patients at 2 tertiary referral centers. Data were evaluated in 3 ways: on a per-treatment session basis for each aneurysm, at 30 days after each patient's final treatment, and at the last known follow-up examination. Ten (26%) aneurysms were ruptured. At the last angiographic follow-up examination (21.5 +/- 22.9 months), 95% or higher and 100% occlusion rates were documented in 64 and 36% of aneurysms, respectively, with parent vessel preservation maintained in 74%. Stents were required in 25 aneurysms. Twenty percent of treatment sessions resulted in permanent morbidity, and death within 30 days occurred after 8% of treatment sessions. On average, 1.9 +/- 1.1 sessions were required to treat each aneurysm, with a resulting cumulative per-patient mortality of 16% and morbidity of 32%. At the last known clinical follow-up examination (mean, 24.8 +/- 24.8 months), 24 (63%) patients had Glasgow Outcome Scale scores of 4 or 5 ("good" or "excellent"), 10 patients had worsened neurological function from baseline (26% morbidity), and 11 had died (29% mortality). We present what is to our knowledge the largest series to date evaluating outcome after consecutive giant IAs treated with endovascular repair. Giant IAs carry a high risk for surgical or endovascular intervention. We hope critical and honest evaluation of treatment results will ensure continued improvement in patient care.

  15. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    SciTech Connect

    Breault, Stéphane; Glauser, Frédéric; Babaker, Malik Doenz, Francesco Qanadli, Salah Dine

    2015-06-15

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

  16. Radiological changes in infantile dissecting anterior communicating artery aneurysm treated endovascularly. A case report and five-year follow-up.

    PubMed

    Yatomi, Kenji; Oishi, Hidenori; Yamamoto, Munetaka; Suga, Yasuo; Nonaka, Senshu; Yoshida, Kensaku; Arai, Hajime

    2014-12-01

    Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.

  17. Usefulness of non-detachable balloons in endovascular treatment for cerebral aneurysms.

    PubMed

    Nakahara, I; Pile-Spellman, J; Hacein-Bey, L; Crowell, R M; Gress, D

    1994-06-01

    An endovascular non-detachable balloon technique was used to treat 14 patients with cerebral aneurysms. Eight patients presented with subarachnoid hemorrhage, and six others presented with headache or mass effect. Six aneurysms were located in the anterior circulation and eight in the posterior circulation. Seven aneurysms were giant, three were large, and four were small. All target aneurysms or vessels were occluded successfully. Parent vessel was successfully spared in seven cases. There were no procedural complications related to the non-detachable nature of the balloon used. Follow-up angiography detected refilling of aneurysms in three of 11 patients, two with small ruptured aneurysms that bled again following partial deflation or balloon movement. The other aneurysms tested remained occluded, as demonstrated on follow-up angiograms, for up to 15 months. Outcomes were good to excellent in 10 patients, poor in one, and three died. Non-detachable balloons might be preferred for treatment of certain types of cerebral aneurysms including those where intraaneurysmal maneuvers might be considered dangerous, for example, with recent bleeding or intraluminal fresh clots; where precise placement of the balloon is required, for example, in the vicinity of perforators or collaterals emerging near the neck; and where detachment could be dangerous or difficult in broad neck and fusiform aneurysms or in tortuous parent vessels.

  18. The effect of anatomical factors on mortality rates after endovascular aneurysm repair.

    PubMed

    Ay, D; Erdolu, B; Yumun, G; Demir, A; Aydin, U; Ozkan, H; Erkoc, K; Tiryakioglu, O

    2016-01-01

    The objective of this study was to investigate the effect of anatomical characteristics on mortality rates after endovascular aneurysm repair (EVAR). We investigated 56 EVAR procedures for infrarenal aortic aneurysms performed between January 2010 and December 2013, and the data were supplemented with a prospective review. The patients were divided into two groups according to the diameter of the aneurysm. Group I (n = 30): patients with aneurysm diameters less than 6 cm, group II (n = 26): patients with aneurysm diameters larger than 6 cm. The pre-operative anatomical data of the aneurysms were noted and the groups were compared with regard to postoperative results. There were no correlations between diameter of aneurysm (p > 0.05), aneurysm neck angle (p > 0.05) and mortality rate. The long-term mortality rate was found to be high in patients in whom an endoleak occurred. We found that aneurysm diameter did not have an effect on postoperative mortality rates. An increased EuroSCORE value and the development of endoleaks had an effect on long-term mortality rates.

  19. Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair.

    PubMed

    Deery, Sarah E; Ergul, Emel A; Schermerhorn, Marc L; Siracuse, Jeffrey J; Schanzer, Andres; Goodney, Philip P; Cambria, Richard P; Patel, Virendra I

    2017-08-30

    Patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms can exhibit variations in sac behavior ranging from complete regression to expansion. We evaluated the impact of sac behavior at 1-year follow-up on late survival. We used the Vascular Study Group of New England (VSGNE) registry from 2003 to 2011 to identify EVAR patients with 1-year computed tomography follow-up. Aneurysm sac enlargement ≥5 mm (sac expansion) and decrease ≥5 mm (sac regression) were defined per Society for Vascular Surgery guidelines. Predictors of change in sac diameter and impact of sac behavior on long-term mortality were assessed by multivariable methods. Of 2437 patients who underwent EVAR, 1802 (74%) had complete 1-year follow-up data and were included in the study. At 1 year, 162 (9%) experienced sac expansion, 709 (39%) had a stable sac, and 931 (52%) experienced sac regression. Sac expansion was associated with preoperative renal insufficiency (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.5-8.0; P < .01), urgent repair (OR, 2.7; 95% CI, 1.4-5.1; P < .01), hypogastric coverage (OR, 1.7; 95% CI, 1.1-2.7; P = .02), and type I/III (OR, 16.8; 95% CI, 7.3-39.0; P < .001) or type II (OR, 2.9; 95% CI, 2.0-4.3; P < .001) endoleak at follow-up, and sac expansion was inversely associated with smoking (OR, 0.6; 95% CI, 0.4-0.96; P = .03) and baseline aneurysm diameter (OR, 0.7; 95% CI, 0.6-0.9; P < .001). Sac regression (vs expansion or stable sac) was associated with female gender (OR, 1.8; 95% CI, 1.4-2.4; P < .001) and larger baseline aneurysm diameter (OR, 1.4; 95% CI, 1.2-1.5; P < .001) and inversely associated with type I/III (OR, 0.2; 95% CI, 0.1-0.5; P < .01) or type II endoleak at follow-up (OR, 0.2; 95% CI, 0.2-0.3; P < .001). After risk-adjusted Cox regression, sac expansion was independently associated with late mortality (hazard ratio, 1.5; 95% CI, 1.1-2.0; P = .01), even with adjustment for reinterventions and endoleak during

  20. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    SciTech Connect

    Godfrey, Anthony D. Morbi, Abigail H. M. Nordon, Ian M.

    2015-10-15

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.

  1. Evaluation of the learning curve for fenestrated endovascular aneurysm repair.

    PubMed

    Starnes, Benjamin W; Caps, Michael T; Arthurs, Zachary M; Tatum, Billi; Singh, Niten

    2016-11-01

    The objective of this study was to evaluate the learning curve for fenestrated endovascular aortic aneurysm repair (FEVAR). Data were collected prospectively on all FEVAR procedures conducted by a single surgeon between June 2007 and January 2015. During the study period, 136 FEVARs were performed, and this experience was divided into four quartiles each consisting of 34 cases. Clinical outcomes evaluated included perioperative death and major complications. Process outcomes included length of procedure, fluoroscopy time, contrast material use, estimated blood loss, and intensive care unit length of stay. During the study period, there was a statistically significant increase in the complexity of cases as evidenced by an increase in the proportion of cases with two or more fenestrations from 52.9% in the first quartile to 88.2% in the fourth quartile (P = .001). Despite this, there was a steady decrease in the proportion of patients suffering perioperative death or major complications from 23.5% in the first quartile to 8.8% in the fourth quartile. After adjustment for potential confounding factors, the odds of death or major complication were cut by 52.4% per quartile increase (95% confidence interval [CI], 7.8%-75.5%; P = .028). In addition, among cases with two or more fenestrations, geometric mean length of procedure was reduced from 223.8 minutes in the first quartile to 149.6 minutes in the fourth quartile, and geometric mean fluoroscopy time was reduced from 58.6 minutes in the first quartile to 31.5 minutes in the fourth quartile. After adjustment, there was an estimated 9.9% reduction in geometric mean procedure length per quartile increase (95% CI, 3.5%-15.9%; P = .003) and a 17.6% reduction in geometric mean fluoroscopy time per quartile increase (95% CI, 10.9%-23.8%; P < .0001). Despite an increase in case complexity, there was evidence for significant improvement in important clinical and process outcomes during the study period. We believe

  2. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    PubMed

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR.

  3. Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion.

    PubMed

    Serbinenko, F A; Filatov, J M; Spallone, A; Tchurilov, M V; Lazarev, V A

    1990-07-01

    Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.

  4. Use of T-Stat to predict colonic ischemia during and after endovascular aneurysm repair: a case report.

    PubMed

    Lee, Eugene S; Pevec, William C; Link, Daniel P; Dawson, David L

    2008-03-01

    As surgeons become more aggressive in treating aneurysms with endovascular techniques, traditional surgical principles of preserving internal iliac arteries and the inferior mesenteric artery have been challenged. A case is presented where the T-Stat device (Spectros Corp, Portola Valley, Calif), an optical real-time sensor approved by United States Food and Drug Administration for measuring colon ischemia, was used as an adjunctive measure to assist in the successful endovascular aneurysm repair in a patient at high risk for colon ischemia.

  5. Changing Paradigms in the Endovascular Management of Ruptured Anterior Communicating Artery Aneurysms.

    PubMed

    Moon, Karam; Park, Min S; Albuquerque, Felipe C; Levitt, Michael R; Mulholland, Celene B; McDougall, Cameron G

    2017-10-01

    Approximately 17% of ruptured anterior communicating artery (ACoA) aneurysms were deemed unsuitable for coil embolization during the Barrow Ruptured Aneurysm Trial (BRAT), most commonly due to unfavorable dome-to-neck ratio or small size. To compare patients treated by coil embolization for ruptured ACoA aneurysms during the trial to those treated after the trial to determine whether advances in endovascular techniques have allowed for effective treatment of these lesions. All cases of ruptured ACoA aneurysms treated by endovascular modalities during BRAT (2003-2007) and post-BRAT (2007-2012) were reviewed for patient and aneurysm characteristics, treatment types, and clinical and angiographic outcomes at 3-yr or last follow-up. The BRAT ACoA cohort included 39 patients treated with coiling (excluding those crossed over to clipping). The post-BRAT cohort included 93 patients who were significantly older (mean age, 59.5 vs 52.8 yr, P = .005) than the BRAT cohort; there were no significant cohort differences in sex, Hunt and Hess grade, or mean aneurysm size. The use of balloon remodeling was significantly higher in the post-BRAT cohort (31.2% [29/93] vs 5.1% [2/39], P = .001), as was the proportion of wide-necked aneurysms treated (66.7% [62/93] vs 30.8% [12/39], P < .001). There was no significant difference in clinical outcome or retreatment rate between the 2 cohorts (P = .90 and P = .48, respectively). ACoA lesions thought unamenable to endovascular therapy in an earlier randomized trial are now successfully coiled with increased use of adjunctive techniques, without sacrificing patient outcome or treatment durability.

  6. Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms

    PubMed Central

    Juszkat, R.; Nowak, S.; Smól, S.; Kociemba, W.; Blok, T.; Zarzecka, A.

    2007-01-01

    Summary The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery15, basilar artery5, basilar tip3, posterior inferior cerebral artery2, M1/M2 segment1, A2 segment1 and vertebral artery1. There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broadnecked and fusiform intracranial aneurysms is safe and effective with a low complication rate. PMID:20566117

  7. Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm

    PubMed Central

    Zhang, Linjing; Wang, Yunxia; Zhang, Qingkui; Ge, Wei; Wu, Xiancong; Di, Hai; Wang, Jun; Cao, Xiangyu; Li, Baomin; Liu, Ruozhuo; Yu, Shengyuan

    2017-01-01

    Abstract The aim of this study was to investigate whether there is a long-term improvement in headache of patients with unruptured intracranial aneurysms (UIAs) treated with intracranial endovascular procedures. Using a prospective design, consecutive patients with UIAs with neuroendovascular treatment from January 2014 to December 2014 were asked to participate. Headache outcomes were established before aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated. Ultimately, 58 patients completed the 6-month follow-up. In total, 29 patients had preoperative headache. Six months after the intracranial endovascular procedure, 13 patients (44.8%) stated that their headaches were relieved after endovascular treatment; headache in 1 patient improved slightly, and 12 reported disappearance of headache and marked improvement. Overall, the mean headache scores of 29 patients improved on the self-reported Numeric Rating Scale (NRS) after endovascular treatment (6.00 vs. 2.30; P < 0.001). Patients with pretreatment tension-type headache, more severe headaches, stent-assisted coiling, and stent implantation of the aneurysm were the important disadvantage for patients in improvement of post-procedure headache. Treatment of UIAs resulted in relief of headaches in about half of patients who had headaches pre-operatively. PMID:28178166

  8. Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling.

    PubMed

    Ahn, Jung Yong; Cho, Jun Hyung; Jung, Jin Young; Lee, Byung Hee; Yoon, Pyeong Ho

    2008-09-01

    ''Blister-like'' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.

  9. Endovascular Stent Grafting for Aortic Arch Aneurysm in Aortoiliac Occlusive Disease following Aortic Arch Debranching and Aortobifemoral Reconstruction

    PubMed Central

    Canbay, Cagla; Onal, Yilmaz; Beyaz, Metin Onur; Sayin, Omer Ali; Barburoglu, Mehmet; Yornuk, Mesut; Acunas, Bulent; Alpagut, Ufuk; Dayioglu, Enver

    2017-01-01

    Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient. In these situations stent grafting may even be more complicated. In this report, we present the treatment of a 92-year-old patient with aortic arch aneurysm and proximal descending aortic aneurysm. For successful thoracic endovascular stent grafting, the patient needed an alternative route other than the native femoral and iliac arteries for the deployment of the stent graft. In addition, debranching of left carotid and subclavian arteries from the aortic arch was also required for successful exclusion of the thoracic aneurysm. PMID:28408933

  10. Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm

    SciTech Connect

    Zayed, Hany A. Attia, Rizwan; Modarai, Bijan; Clough, Rachel E.; Bell, Rachel E.; Carrell, Tom; Sabharwal, Tarun; Reidy, John; Taylor, Peter R.

    2011-02-15

    The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan-Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.

  11. Systematic Review and Single-Center Experience for Endovascular Management of Visceral and Renal Artery Aneurysms.

    PubMed

    Kok, Hong Kuan; Asadi, Hamed; Sheehan, Mark; Given, Mark F; Lee, Michael J

    2016-11-01

    To report a systematic review of endovascular management of visceral and renal artery aneurysms (VRAA) and results at a tertiary referral center. A literature review was performed via a comprehensive electronic search of PubMed, MEDLINE, EMBASE, and Cochrane databases, followed by retrospective analysis of all VRAAs treated at a tertiary referral center from January 1999 to December 2015. The systematic review included 22 studies published between 2005 and 2016 describing endovascular treatment of VRAA. In the systematic review cohort, 646 aneurysms (432 true, 151 false, 63 unclassified) were treated using endovascular methods with 93.2% technical success, 99.3% visceral preservation, 3.5% major complication (classified based on Society of Interventional Radiology criteria), 1.5% 30-day periprocedural mortality, and 4.6% reintervention rates. In the local cohort, 19 aneurysms (12 true, 7 false) were treated with 100% technical success, 94.7% visceral preservation, and 10.5% major complication rates. There was no periprocedural mortality. Over mean follow-up of 31.9 months (range, 2-170 months), there were 2 aneurysm reperfusions, which required no further treatment. Results incorporating data from the systematic review and local cohorts (665 aneurysms) showed 93.6% technical success, 99.1% visceral preservation, 3.7% major complication, 1.5% periprocedural mortality, and 4.4% reintervention rates. Endovascular treatment of VRAA is associated with excellent technical success and visceral preservation rates. Major complication and periprocedural mortality rates are comparatively low. A few VRAA (4.4%) required future reintervention suggesting that imaging follow-up is essential after initial treatment. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  12. Percutaneous endovascular removal of intracardiac migrated port A catheter in a child with acute lymphoblastic leukemia.

    PubMed

    Cakır, Feraye; Geze, Sukran; Ozturk, M Halil; Dınc, Hasan

    2014-01-01

    A 2-year-old boy with acute lymphoblastic leukemia was presented with peripherally inserted central catheter dysfunction. Radiological examinations revealed a catheter remnant in the right atrium extending into pulmonary vein. The catheter remnant was successfully removed from the right atrium by percutaneous endovascular intervention without any complications. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Fluid-structure interaction simulation of a cerebral aneurysm: Effects of endovascular coiling treatment and aneurysm wall thickening.

    PubMed

    Shamloo, Amir; Nejad, Milad Azimi; Saeedi, Milad

    2017-10-01

    In the present study, we investigate the effect of the hemodynamic factors of the blood flow on the cerebral aneurysms. To this end, a hypothetical geometry of the aneurysm in the circle of Willis, located in the bifurcation point of the anterior cerebral artery (ACA) and anterior communicating artery (ACoA) is modeled in a three-dimensional manner. Three cases are chosen in the current study: an untreated thin wall (first case), untreated thick wall (second case), and a treated aneurysm (third case). The effect of increasing the aneurysm wall thickness on the deformation and stress distribution of the walls are studied. The obtained results showed that in the second case, a reduction in the deformations of the walls was observed. It was also shown that the Von Mises stress has a 10% reduction in the untreated thick wall aneurysm compared to the untreated thin wall aneurysm. Thus, increasing the thickness of the aneurysm wall can be proposed as temporary remedial action. In the third case, an aneurysm that has been treated by endovascular coiling is investigated. The deformation and Von Mises stress in this case was decreased more than 43% and 87% compared to the first case, respectively. The wall shear stress distribution due to the fluid flow in the first and second cases showed small amounts of shear stress on the aneurysm sac. In these two cases, the oscillatory shear index was measured to have an approximate value of 0.47 in the aneurysm region, though, this value was measured to be about 0.1 for the third case. The hybrid effect of the wall shear stress and the oscillatory shear index on the relative residence time (RRT) was also studied. When this parameter reaches its maximum, the aneurysm rupture may occur. It was shown that by treating the aneurysm (the third case), RRT parameter can be decreased ~200 times relative to the first and second cases, which suggests an appropriate treatment of the aneurysm by choosing the coiling method. Copyright © 2017

  14. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    SciTech Connect

    Patel, Rakesh P.; Katsargyris, Athanasios Verhoeven, Eric L. G.; Adam, Donald J.; Hardman, John A.

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  15. Morbidity of endovascular abdominal aortic aneurysm repair is directly related to diameter.

    PubMed

    Overbey, Douglas M; Glebova, Natalia O; Chapman, Brandon C; Hosokawa, Patrick W; Eun, John C; Nehler, Mark R

    2017-10-01

    Previous randomized controlled trials have defined specific size thresholds to guide surgical decision-making in patients presenting with an abdominal aortic aneurysm (AAA). With recent advances in endovascular techniques, the anatomic considerations of AAA repair are rapidly changing. Our specific aims were to evaluate the most recent national population data to compare anatomic differences and perioperative outcomes in patients with AAA. The American College of Surgeons National Surgical Quality Improvement Program was queried from 2011 to 2015 using the targeted vascular public use file. Patients with AAA undergoing elective open or endovascular repair were included. Risk factors and outcomes were stratified by size and divided into quartiles for categorical comparison. A logistic regression model was used to compare the impact of size on morbidity and mortality with each technique. A risk adjustment model used all preoperative criteria to generate observed and expected values for open and endovascular repair. There were 10,026 patients who underwent elective AAA repair, 8182 (81.6%) endovascular and 1844 (18.4%) open. Repairs were divided into density quartiles for a logistic analysis: smallest quartile, 3.5 to 5 cm; second quartile, 5.01 to 5.5 cm; third quartile, 5.51 to 6.2 cm; and largest quartile, >6.2 cm. Patients with larger aneurysms (>6.2 cm) were more likely to be male, to have a dependent functional status, and to have increased blood urea nitrogen concentration and American Society of Anesthesiologists score (P < .05). Larger aneurysms had longer operative time (162 vs 135 minutes) and greater extension toward the renal and iliac vessels (all P < .05). Risk adjustment revealed an observed/expected morbidity plot that favored endovascular repair throughout the size range but confirmed lack of size effect within the open repair category. The adjusted increase in morbidity with endovascular repair is 9.7% per centimeter increase in size of AAA

  16. Endovascular management of ruptured common iliac mycotic aneurysm in an HIV-positive patient.

    PubMed

    Aziz, Aamir; Mooka, Busi; Clarke Moloney, Mary; Kavanagh, Eamon

    2013-08-05

    Isolated iliac artery aneurysms are a rare entity. The majority of cases are asymptomatic and often escape detection. Mortality rates after sudden rupture and emergent surgery for iliac artery aneurysm are very high. We report a case of a 56-year-old man who presented with right hip pain masquerading as septic arthritis or psoas abscess. CT showed ruptured right common iliac artery aneurysm with extensive active extravasation into psoas with a retroperitoneal haematoma. Aneurysm was repaired using an endovascular technique. Postoperative recovery was eventful with the patient experiencing severe back pain radiating down the leg accompanied with fever. CT showed persistent, right iliopsoas haematoma and pelvic haematoma with secondary hydronephrosis. Viral screen for hepatitis B, C and HIV returned positive. The patient was started on intravenous meropenem. Fever and pain settled. Repeated CT scan showed decrease in retroperitoneal pelvic haematoma.

  17. Endovascular repair for an extracranial internal carotid aneurysm with cervical access: A case report

    PubMed Central

    Rivera-Chavarría, Ignacio J.; Alvarado-Marín, Juan C.

    2015-01-01

    Background Carotid aneurysms are a rare pathology. This vascular disorder can be asymptomatic or it can cause local compression. The disorder poses a high risk of embolization and rupture. Presentation of case A 79 years old female, presents with a right internal carotid fusiform aneurysm, approximately 3.8 cm in diameter, localized 3.30 cm from the common carotid artery bifurcation with an extremely tortuous common carotid artery. Discussion Surgical management of the extracranial internal carotid artery remains varying and challenging, particularly with a distal internal carotid aneurysm and with anatomical difficulties. Conclusion Endovascular management of an internal carotid aneurysm with cervical access using an expanded polytetrafluoroethylene covered stent with Heparin Bioactive Surface in the carotid area, is safe and effective. PMID:26706595

  18. Idiopathic Lingual Artery Aneurysm: CT Findings and Endovascular Therapy

    PubMed Central

    Brindle, R.S.; Fernandez, P.M.; Sattenberg, R.J.; Flynn, M.B.; Heidenreich, J.O.

    2010-01-01

    Summary We describe a 65-year-old woman with an asymptomatic idiopathic lingual artery aneurysm which is suspected to be congenital. We review the literature on external carotid artery branch aneurysms, diagnostic evaluation and discuss treatment options for the various types and the specific chosen in the case presented. PMID:20377988

  19. Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm

    PubMed Central

    Kwon, S.C.; Lyo, I.U.; Shin, S.H.; Park, J.B.; Kim, Y.

    2008-01-01

    Summary Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting. PMID:20557732

  20. Challenging neck anatomy is associated with need for intraoperative endovascular adjuncts during endovascular aortic aneurysm repair (EVAR).

    PubMed

    Grisafi, Joseph L; Rahbar, Rodeen; Nelms, Justin; Detschelt, Elizabeth L; Chess, Bart A; Benckart, Daniel H; Muluk, Satish C

    2011-08-01

    The purpose of this study was to determine which proximal seal zone characteristics were predictive of early and late type Ia endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease. We evaluated 146 patients who underwent EVAR between January 2006 and March 2007. In the cohort, high-resolution computed tomography images of 100 (68.5%) patients were available, which showed detailed measurement of proximal neck parameters, including diameter, length, calcification, thrombus, suprarenal and infrarenal angles, and reverse taper morphology. Postprocessing of digital data sets was performed to obtain centerline-of-flow measurements. Relevant medical records and follow-up computed tomography scans were reviewed. Mean age of the patients was 72.7 years, with 78% being male. Of these patients, 66% did not satisfy the instructions for use for the Zenith EVAR device, and 50% did not satisfy the instructions for use for the AneuRx device. Nine patients had intraoperative type Ia endoleaks. A 100% assisted primary technical success rate was achieved with the adjunctive use of angioplasty (n = 4), uncovered stent (n = 3), and extension cuff (n = 2) placement. There was a significant association between type Ia endoleak development and magnitude of the infrarenal angle (p < 0.01); however, other parameters were not significant. At follow-up (mean, 587 days), no patient had a type Ia endoleak, and there were no aneurysm-related deaths. Our data indicate that infrarenal angle is related to intraoperative type Ia endoleak occurrence, but other factors often thought to be indicative of adverse neck anatomy are not significant predictors. Moreover, all type Ia endoleaks in this cohort were successfully eliminated intraoperatively, and durability was confirmed on postoperative surveillance. These data demonstrate that challenging neck anatomy is associated with the need for intraoperative endovascular adjuncts, and that

  1. Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate

    PubMed Central

    Cheng-Ching, Esteban; John, Seby; Bain, Mark; Toth, Gabor; Masaryk, Thomas; Hui, Ferdinand; Hussain, Muhammad Shazam

    2017-01-01

    Introduction Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Methods Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Results Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Conclusions Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible. PMID:28611838

  2. Early Experiences of Sandwich Technique to Preserve Pelvic Circulation during Endovascular Aneurysm Repair.

    PubMed

    Kim, Daehwan; Chung, Jung Kee; Park, Hyung Sub; Jung, In Mok; Lee, Taeseung

    2017-06-01

    To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9-1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.

  3. Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

    SciTech Connect

    Baumueller, Stephan Nguyen, Thi Dan Linh Goetti, Robert Paul; Lachat, Mario; Seifert, Burkhardt; Pfammatter, Thomas Frauenfelder, Thomas

    2011-12-15

    Purpose: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. Materials and Methods: Forty-nine consecutive patients (73 {+-} 7.5 years, range 51-88 years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2 years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5 cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. Results: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC = 0.98 and ICC = 0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r = 0.93, P < 0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r = 0.93, P < 0.001). Conclusion: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routine.

  4. Endovascular treatment of unruptured intracranial aneurysms by the woven endobridge device (web): are there any aspects influencing aneurysm occlusion?

    PubMed

    Limbucci, Nicola

    2017-09-28

    The experience with Woven Endobridge Device (WEB) is still limited. The aim of this study is to discuss the efficacy of this new device focusing on any anatomical and procedural factors influencing aneurysm occlusion. Between October 2011 and November 2016, 24 patients (10 females,14 males) harbouring 24 cerebral aneurysms treated with WEB in a single centre were retrospectively reviewed. Patients underwent 6-months and 12-24 months (median 18 months) clinical and neuroradiological follow-up. We evaluated if any procedural or anatomical aspect could influence the occlusion rate. Adequate occlusion (AO) was achieved in 68% of cases at 6-months and in 87% at 18-months follow-up respectively. Technical difficulties occurred in three procedures (12.5%). No post-procedural morbidity was reported. One patient (4%) died after 1 months for reasons unrelated to the procedure. Neck size and dome-to- neck ratio were significantly associated to aneurysm occlusion (P<0.05). AO was not associated to post-operative dual antiplatelet therapy (P>0.99) or device compression at both first and second follow-up (P>0.99). Immediate contrast agent stagnation was more common in aneurysms that were occluded at first (P=0.37) and second follow-up (P=0.24) but statistical significance was not reached. Endovascular treatment with WEB is a safe treatment for unruptured cerebral aneurysms, resulting in a good AO rate also in aneurysms that would otherwise require complex assisted coiling techniques. However, results are less favourable in case of very large aneurysmal neck. Nevertheless, further series with larger patient population and longer follow-up will define the WEB role in aneurysms treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Endovascular Treatment of Spontaneous Isolated Dissecting Aneurysm of the Superior Mesenteric Artery Using Stent-Assisted Coil Embolization

    SciTech Connect

    Ozaki, Toshiro Kimura, Motomasa; Yoshimura, Norihiko; Hori, Yoshiro; Takano, Toru; Kamura, Takesi; Yamamoto, Satoshi; Sasai, Keisuke

    2006-06-15

    Spontaneous isolated dissecting aneurysm of the main trunk of the superior mesenteric artery is a rare condition. We treated a patient with this condition successfully by stent-assisted coil embolization. Intravascular stent placement may widen the indications for endovascular coiling of the aneurysmal false lumen to avoid perforation.

  6. Combined Endovascular Repair of a Celiac Trunk Aneurysm Using Celiac-Splenic Stent Graft and Hepatic Artery Embolization

    SciTech Connect

    Carrafiello, Giampaolo; Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele; Mariscalco, Giovanni; Bracchi, Elena; Ferrario, Massimo

    2010-04-15

    Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization.

  7. Endovascular Treatment of Internal Carotid and Vertebral Artery Aneurysms Using a Novel Pericardium Covered Stent

    PubMed Central

    Vulev, I.; Klepanec, A.; Bazik, R.; Balazs, T.; Illes, R.; Steno, J.

    2012-01-01

    Summary Intracranial aneurysm is a fairly common (often asymptomatic) condition. Subarachnoid hemorrhage associated with aneurysmal rupture is a potentially lethal event with a mortality rate as high as 50 percent and a high rate of disability among those who survive the initial hemorrhage, such that recently published guidelines support treatment of intracerebral aneurysms. The current treatment options include surgical clipping and endovascular treatment, but these are not without significant problems. Despite the trend toward endovascular treatment the rate of recurrence and complications is high. Current published evidence of the use of covered stent is limited to stents covered with polytetrafluoroethylene. It is now recognized that mammalian extracellular matrix represents an excellent scaffold material suitable for many therapeutic applications and glutaraldehyde treated pericardium has been widely used for many years due to its desirable features such as low immunogenicity and durability. This report describes the first published experience with the Aneugraft Pericardium Covered Stent (ITGI Medical, OR Akiva, Israel) in the treatment of internal carotid and vertebral artery aneurysms in three patients. In all three cases, the implantation of this novel device has resulted in successful closure of aneurysms. PMID:22681731

  8. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    SciTech Connect

    Ricci, Carmelo; Ceccherini, Claudio Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-02-15

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  9. Transapical endovascular aortic aneurysm repair in a patient with shaggy aorta syndrome.

    PubMed

    Murakami, Takashi; Kawatani, Yohei; Nakamura, Yoshitsugu; Hori, Takaki

    2015-05-01

    We report a case of a 68-year-old man with a large saccular aneurysm (70 mm) of the aortic arch. Although abundant atherosclerotic plaques or mural thrombi are generally considered to be a contraindication for endovascular repair, the patient's multiple comorbidities and anatomic limitations with a patent internal thoracic artery graft adjacent to the aneurysm made him unfit for open repair. Transapical deployment of the endograft through the less-diseased ascending aorta, with a concomitant chimney graft and carotid-carotid bypass, was performed, without evident stroke or embolism.

  10. Use of spiral computed tomographic angiography in monitoring abdominal aortic aneurysms after transfemoral endovascular repair.

    PubMed Central

    Balm, R; Jacobs, M J

    1997-01-01

    Transfemoral endovascular repair of abdominal aortic aneurysms has proved to be technically feasible in a selected group of patients. However, long-term efficacy has not been proved. Graft performance after implantation can be monitored by a single imaging technique: spiral computed tomographic angiography. With this technique, the parameters for continuing clinical success of the procedure-graft patency, endoleaks, graft migration, attachment site diameter, attachment system failure, and aneurysm diameter-can be monitored. Only in selected cases will an additional imaging technique be necessary. PMID:9339508

  11. Successful endovascular treatment of hemosuccus pancreaticus due to splenic artery aneurysm associated with segmental arterial mediolysis.

    PubMed

    Obara, Hideaki; Matsubara, Kentaro; Inoue, Masanori; Nakatsuka, Seishi; Kuribayashi, Sachio; Kitagawa, Yuko

    2011-11-01

    Hemosuccus pancreaticus, which is generally due to the rupture of a splenic artery aneursym into the pancreatic duct, is a rare cause of intermittent upper gastrointestinal hemorrhage. Segmental arterial mediolysis (SAM) is a rare arteriopathy. We report a 53-year-old man with hemosuccus pancreaticus due to a splenic artery aneurysm associated with SAM. The patient, who also had a celiac artery aneurysm affected by SAM, was successfully treated by both coil embolization and aortic stent grafting for complete coverage of the celiac artery. SAM is a very rare cause of hemosuccus pancreaticus, and endovascular treatment may be favorable for hemosuccus pancreaticus.

  12. CT imaging findings and endovascular management of isolated spontaneous dissecting aneurysm of celiac artery.

    PubMed

    Rama Krishnan, Rs; Murali, K; Madan, R; Francis, G

    2013-07-01

    Isolated spontaneous dissecting aneurysm of celiac artery without concomitant involvement of aorta is a rare entity and only a few cases are reported in the literature. More cases are being detected recently with greater advancements in CT technology. Clinicians and emergency physicians should be aware of this condition and should include it in the differential diagnosis of patients who present with refractory postprandial epigastric pain, particularly in middle-aged men. We present a case of a 45-year-old male with isolated spontaneous dissecting celiac artery aneurysm, with special emphasis on CT findings and the role of endovascular management.

  13. Repair of type I endoleak by chimney technique after endovascular abdominal aortic aneurysm repair

    PubMed Central

    Kim, Na Hee; Kim, Woo Chul; Cho, Soon Gu; Hong, Kee Chun

    2014-01-01

    Endovascular aneurysm repair is a minimally invasive, durable and effective alternative to open surgery for treatment of abdominal aortic aneurysms (AAA). However, in patients who do not have an adequate sealing zone, open surgical repair is required, which may increase mortality and morbidity. An alternative treatment in patients with challenging anatomy is the so-called "chimney graft" technique. Here, we describe a case using the chimney graft technique for treatment of juxtarenal type I endoleak followed by a previous conventional stent graft insertion to the AAA with good results. PMID:24851230

  14. JAG tearing technique with radiofrequency guide wire for aortic fenestration in thoracic endovascular aneurysm repair.

    PubMed

    Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-02-01

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  15. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    PubMed

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  16. Rupture of intracranial aneurysms during endovascular coiling: management and outcomes.

    PubMed

    Levy, E; Koebbe, C J; Horowitz, M B; Jungreis, C A; Pride, G L; Dutton, K; Kassam, A; Purdy, P D

    2001-10-01

    In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed. A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge. Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52-85 yr). Mean follow-up time was 8 months (range, 0-25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients. The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.

  17. Effect of improved endograft design on outcome of endovascular aneurysm repair.

    PubMed

    Torella, Francesco

    2004-08-01

    This study was undertaken to identify factors that lead to improvements in the results of endovascular aneurysm repair, with particular focus on new endograft design. We analyzed data for patients enrolled in the European Collaborators on Stent Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR) registry, and compared those for endografts now withdrawn from the market with those for endografts currently in use. Patients in whom a variety of endograft types were used in small numbers were excluded. Postoperative and long-term outcomes were initially compared with univariate analyses, and subsequently multivariate tests were used to adjust for baseline differences between the 2 groups. The main outcome measures were freedom from a variety of secondary interventions, aneurysm rupture, and death. Some 1224 patients received "withdrawn" endografts, and 2768 patients received "current" endografts. The 2 groups were generally similar, but patients with current devices were more often men, significantly older, more frequently unfit for open surgery, and had larger aneurysms with wider necks. Of no surprise, current endografts were also more often used by experienced (>60 previous cases) surgical teams (44% vs 20%; P <.0001). Thirty-day clinical outcomes were comparable in the 2 groups, although patients with withdrawn devices were less likely to have type II endoleak (9.2% vs 5.5%; P <.0001), and those with current devices had a shorter mean hospital stay (5.4 vs 6.8 days; P <.0001). At 3 years more patients with current devices were free from secondary transfemoral intervention (88.4% vs 76%; P <.0001) and conversion to open repair (95.4% vs 93.4%; P =.007). Aneurysm-related mortality at 3 years, defined as death due to aneurysm rupture or within 30 days of a secondary intervention, was also less frequent with current endografts (2.7% vs 4.4%; P =.02). Aneurysm rupture at 3 years was infrequent (0.8% vs 1.8%; P =.07). At multivariate analysis the use of

  18. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    SciTech Connect

    Kristensen, Katrine Lawaetz; Duus, Louise Aarup; Elle, Bo

    2015-10-15

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone.

  19. A tissue-engineered aneurysm model for evaluation of endovascular devices.

    PubMed

    Touroo, Jeremy S; Williams, Stuart K

    2012-12-01

    Endovascular stent grafts used for treatment of arterial aneurysms require preclinical testing for investigation of biological responses following implantation. The preclinical evaluation process related to the safety and efficacy of these devices is limited by the absence of an in vitro aneurysmal blood vessel equivalent capable of providing high-throughput, cost-effective assessments. With this in mind, the focus of this work was to develop an aneurysm model consisting of human blood vessel cells. To create aneurysmal scaffolds, expanded polytetrafluoroethylene vascular grafts were dilated utilizing an angioplasty balloon. Stromal vascular fraction cells isolated from human adipose tissue were integrated with the scaffolds, and luminal flow of nutrient medium was executed for 14 days in a vascular bioreactor. Following bioreactor perfusion, histology verified that a neointimal lining of human tissue had formed. Immunohistochemistry and scanning electron microscopy revealed a flow-contacting layer of smooth muscle cells, characterizing the model as a representation of neointimal formation in an injured or diseased vessel. This study has demonstrated the engineering of a vascular construct containing an aneurysmal dilation. A tissue-engineered aneurysm model could provide an alternative to current nonbiological in vitro aneurysm models and serve as a practical tool in the progression of new devices toward in vivo studies.

  20. Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature.

    PubMed

    Veger, H T C; Hedeman Joosten, P Ph; Thoma, S R; Visser, M J T

    2013-02-01

    Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.

  1. Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

    SciTech Connect

    Cariati, Maurizio; Mingazzini, Pietro; Dallatana, Raffaello; Rossi, Umberto G.; Settembrini, Alberto; Santuari, Davide

    2013-05-02

    Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

  2. Thoracic endovascular aortic repair with visceral arteries intermittent clamp technique for descending thoracic aortic aneurysm with shaggy aorta.

    PubMed

    Igarashi, Takashi; Takase, Shinya; Satokawa, Hirono; Misawa, Yukitoki; Wakamatsu, Hiroki; Yokoyama, Hitoshi

    2013-10-01

    Aortic repair for severely atheromatous aneurysm remains a challenge. We used an intermittent clamp technique for all visceral arteries during thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm with a "shaggy aorta" to prevent systemic thromboembolism. In addition, we applied an extracorporeal circulation circuit to trap the thrombi during the endovascular repair. Postoperatively, no embolic complications were seen, and microscopic examination showed trapped plaques on the filter. We conclude that this technique is an option for preventing thromboembolism in aortic aneurysm repair in the context of a shaggy aorta when substantial concern of distal diffuse atheromatous emboli is raised based on clinical history or clear evidence on imaging.

  3. Endovascular repair of inflammatory abdominal aortic aneurysms: a valuable alternative?--Case report and review of literature.

    PubMed

    Ruppert, Volker; Verrel, Frauke; Kellner, Wolfgang; Brandl, Thomas; Reininger, Cornelia B; Steckmeier, Bernd

    2004-05-01

    While endovascular repair (ER) has become a routine procedure in the treatment of arteriosclerotic abdominal aortic aneurysms with a suitable configuration, only rare reports of interventional treatment of inflammatory aortic abdominal aneurysms (IAAA) exist. We present a case study of a male patient with IAAA, who presented with inflammatory thickening involving the entire circumference of the aortic vessel wall. The MRI performed 8 months after successful ER demonstrated complete regression of vessel wall induration. A patient with the appropriate anatomical configuration of IAAA should benefit from the lower morbidity and mortality of endovascular aneurysm repair (EVAR). In our view, EVAR is preferable to open surgical repair in the specific situation of IAAA.

  4. Endovascular Management of True Renal Arterial Aneurysms: Results from a Single Centre

    SciTech Connect

    Chung, Raymond; Touska, Philip; Morgan, Robert; Belli, Anna-Maria

    2016-01-15

    PurposeTo report a single centre’s experience of the endovascular treatment of renal arterial aneurysms, including techniques and outcomes.Materials and MethodsThis is a retrospective analysis of true renal arterial aneurysms (TRAAs) treated using endovascular techniques over a period of 12 years and 10 months. The clinical presentations, aneurysm characteristics, endovascular techniques and outcomes are reported.ResultsThere were nine TRAA cases with a mean aneurysm size of 21.0 mm, located at the main renal arterial bifurcation in all cases. Onyx{sup ®} was used as the embolic agent of choice (88.9 % cases), with concurrent balloon remodelling. The overall primary technical success rate was 100 %. Repeat intervention was carried out in 1 case, secondary to reperfusion >8 years post-initial treatment. Long-term clinical follow-up was available in 55.6 % of cases (mean 29.8 months; range 3.3–90.1 months). Early post-procedural renal function, as measured by serum creatinine, remained within the normal reference range. Renal parenchymal loss post-embolisation was ≤20 % in 77.8 % of cases, as estimated on imaging. Minor complications included non-target embolization of Onyx{sup ®} with no clinical sequelae (n = 1), transient pain requiring only oral analgesia with no prolongation of hospital stay (n = 2). No major complications occurred as a consequence of embolisation.ConclusionEndovascular therapy is an effective and safe primary therapy for TRAA with high success rate and low morbidity, supplanting surgery as primary therapy. Current experience in the use of Onyx{sup ®} in TRAA is primarily limited to individual case reports, and this represents the largest case series of Onyx{sup ®}-treated TRAAs to date.

  5. Late neurological recovery of paraplegia after endovascular repair of an infected thoracic aortic aneurysm.

    PubMed

    Mees, Barend M E; Bastos Gonçalves, Frederico; Koudstaal, Peter J; Verhagen, Hence J M

    2013-02-01

    Spinal cord ischemia is a potentially devastating complication after thoracic endovascular aorta repair (TEVAR). Patients with spinal cord ischemia after TEVAR often develop paraplegia, which is considered irreversible, and have significant increased postoperative morbidity and mortality. We report the case of a patient with unusual late complete neurologic recovery of acute-onset paraplegia after TEVAR for an infected thoracic aortic aneurysm. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  6. Acute Bilateral Renal Artery Chimney Stent Thrombosis after Endovascular Repair of a Juxtarenal Abdominal Aortic Aneurysm

    PubMed Central

    Scali, Salvatore T.; Feezor, Robert J.; Huber, Thomas S.; Beck, Adam W.

    2014-01-01

    The use of “chimney” stents to augment the proximal landing zone (LZ) for endovascular aneurysm repair (EVAR) has been increasingly reported. Despite mounting enthusiasm for this technique, the durability of this type of repair and capability to preserve perfusion to target branches remains a paramount concern. Here we report management of a patient presenting with acute bilateral renal chimney stent thrombosis and a Type 1a endoleak. PMID:24246538

  7. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms.

    PubMed

    Schoretsanitis, Nikolaos; Georgakarakos, Efstratios; Argyriou, Christos; Ktenidis, Kiriakos; Georgiadis, George S

    2017-04-01

    Endovascular repair of abdominal aortic aneurysms has widely replaced the open surgical repair due to its minimal invasive nature and the accompanying lower perioperative mortality and morbidity. During the past two decades, certain improvements and developments have provided a wide variety of endograft structural designs and geometric patterns, enabling the physician to approach a more patient-specific treatment of AAA. This review presents the currently available aortic endografts and describes the clinical, technical and mechanical characteristics of them.

  8. Acute Type B Aortic Dissection in a Patient with Previous Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Park, Sung Hun; Rha, Seung-Woon

    2017-01-01

    Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR. PMID:28377913

  9. Endovascular repair versus open surgery in patients in the treatment of the ruptured of aneurysms abdominal.

    PubMed

    Novo Martínez, Gloria María; Ballesteros Pomar, Marta; Menéndez Sánchez, Elena; Santos Alcántara, Eliezer; Rodríguez Fernández, Inés; Zorita Calvo, Andrés Manuel

    2017-01-01

    Rupture of abdominal aortic aneurysm is still a difficult challenge for the vascular surgeon due to the high perioperative mortality. The aim of our study is to describe the characteristics of the population as well as to compare morbidity and mortality in patients undergoing open surgery or endovascular repair in our center. Database with 82 rAAA between January 2002-December 2014, studying two cohorts, open surgery and endovascular repair. Epidemiologic, clinical, surgical techniques, perioperative mortality and complications are analyzed. 82 rAAA cases were operated (men: 80, women: 2). Mean age 72±9.6 years. 76.8% (63 cases) was performed by open surgery. smokers 59, 7%, alcoholism 19.5%, DM 10.9%, AHT: 53.6%, dyslipidemia 30.5%. The most frequent clinical presentation was abdominal pain with lumbar irradiation: 50 cases (20.7% associating syncope). Overall hospital mortality was 58.5%. Hemodynamic shock prior to intervention was associated with increased mortality (p <.001). Anemia, leukocytosis, aneurysm size, sex and age did not show a statistically significant difference with respect to mortality (p>.05). The presence of iliac aneurysms was associated with increased mortality (p <.0045). Perioperative mortality in endovascular repair was 42%, and in open surgery was 63.5% (p>.05). Hospital stay was lower in the endovascular group (p=.3859). Hemodynamic shock and the presence of concomitant iliac aneurysms have a statistically significant association with perioperative mortality in both groups. We found clinically significant differences in mortality, complications and hospital stay when comparing both groups with better results for EVAR, without statistically significant differences. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. [Conventional open surgery of a splenic artery aneurysm following failure of endovascular management].

    PubMed

    da Gama, A D; Ministro, Augusto; Cabral, Gonçalo; Pestana, Cristina

    2013-01-01

    The clinical case of a 73 years old man is reported, complaining for a long time of a persistent abdominal pain in the left upper quadrants, without irradiation and no identified causative factor. These symptoms affected notoriously his quality of life, becoming disabling for his social and professional activities. The investigation by means of CT-scans disclosed a spheric mass, partially calcified, having 44x41mms of maximum size, located between the pancreatic tail and the splenic hilum. A subsequent angio-CT confirmed the diagnosis of a large splenic artery aneurysm and the patient underwent the attempt of an endovascular exclusion by means of an endoprosthesis, which could not be successfully accomplished due to the multiple kinkings and coilings of the splenic artery. Several coils were then used to occlude the aneurismal sac. Contrarily to the expectations, the pain did not disappear after the procedure, becoming even worse, and an open surgical approach was then advised, in another hospital institution, which he promptly accepted. The operation consisted in the resection of the aneurysm and an associated splenectomy, due to multiple infarcts identified in the spleen, consequence of the previous endovascular management. The post operative course was uneventful and he was discharged on day 3. One and four months later he was found in excellent condition and totally pain-free, having resumed his social and professional activities. Based on this clinical case, the authors intend to put an emphasis on this constraint of the endovascular management of peripheral arterial aneurysms, namely on those causing external compression syndromes, painful or others, which can not be relieved by the endovascular exclusion of the aneurysm, as it happened with this patient, thus justifying its presentation and dissemination.

  11. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    PubMed

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A

    2011-12-01

    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  12. Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?

    PubMed Central

    Machado, Rui; Teixeira, Gabriela; Oliveira, Pedro; Loureiro, Luís; Pereira, Carlos; Almeida, Rui

    2016-01-01

    INTRODUCTION: Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. METHODS: A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). RESULTS: Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates. CONCLUSION: Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes. PMID:27737406

  13. Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?

    PubMed

    Machado, Rui; Teixeira, Gabriela; Oliveira, Pedro; Loureiro, Luís; Pereira, Carlos; Almeida, Rui

    2016-01-01

    Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates. Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.

  14. Endovascular treatment of a large ruptured middle cerebral artery bifurcation aneurysm in a 5-week-old infant: case report.

    PubMed

    Lyon, Kristopher A; Arrey, Eliel N; Haider, Ali S; Jeevan, Dhruve S; Benardete, Ethan A

    2017-10-01

    Ruptured intracranial aneurysms are extremely rare in infants. The optimal treatment strategy is not well established. Both microsurgical and endovascular techniques and strategies have been tried, and in the literature there is a significant variability in outcome. The authors report the presentation and successful endovascular treatment of a large, ruptured, middle cerebral artery bifurcation aneurysm in a 5-week-old girl, one of only a few reported in the literature. Clinical and radiological findings at follow-up are also presented. The authors then review the literature on aneurysmal subarachnoid hemorrhage in infants, with particular regard to outcome after either endovascular or open surgical management. They also provide recommendations for follow-up in pediatric patients whose intracranial aneurysms have been treated with coil embolization.

  15. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

    PubMed Central

    Bastos, Roberto Moraes; Filho, Alvaro Razuk; Blasbalg, Roberto; Caffaro, Roberto Augusto; Karakhanian, Walter Khegan; Rocha, Antonio José

    2011-01-01

    OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre- and post-contrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak. PMID:22189725

  16. Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms

    PubMed Central

    Ji, Wenjun; Liu, Aihua; Lv, Xianli; Kang, Huibin; Sun, Liqian; Li, Youxiang; Yang, Xinjian; Jiang, Chuhan

    2016-01-01

    Background and Purpose— Procedure-related neurological complications are common after endovascular treatment of unruptured intracranial aneurysms. We aimed to develop a score to quantify individual patient risk. Methods— We retrospectively analyzed consecutive patients who underwent endovascular treatment for unruptured intracranial aneurysms between January 2012 and September 2015. After excluding those who lost to follow-up and those with fusiform unruptured intracranial aneurysms, included patients were randomly divided into a derivation group (60%) and a validation group (40%). A neurological complication was defined as any transient or permanent increase in the modified Rankin Scale score after aneurysm embolization. A risk score for neurological complications was derived from multivariable logistic regression analyses in the derivation group and validated in the validation group. Results— Overall, 1060 patients were included (636 in the derivation group and 424 in the validation group). The incidence of neurological complications was 5.5% (95% confidence interval, 3.8%–7.4%). A 3-point risk score (S-C-C) was derived to predict neurological complications (size [≥10 mm=1], core areas [yes=1], and cerebral ischemic comorbidity [yes=1]). The incidence of neurological complications varied from 2.2% in 0-point patients to 25.0% in 3-point patients. The score demonstrated significant discrimination (C-statistic, 0.714; 95% confidence interval, 0.624–0.804) and calibration (McFadden R2, 0.102) in the derivation group. Excellent prediction, discrimination, and calibration properties were reproduced in the validation group. Conclusions— One in 20 patients will develop neurological complications after endovascular treatment of unruptured intracranial aneurysms. The S-C-C score may be useful for predicting these adverse outcomes based on variables in daily practice. PMID:26869386

  17. Outcomes of endovascular aneurysm repair performed in abdominal aortic aneurysms with large infrarenal necks.

    PubMed

    Gargiulo, Mauro; Gallitto, Enrico; Wattez, Helene; Verzini, Fabio; Bianchini Massoni, Claudio; Loschi, Diletta; Freyrie, Antonio; Haulon, Stephan

    2017-10-01

    The aim of this study was to evaluate midterm clinical and morphologic outcomes after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) with large (≥28 mm) infrarenal neck. From 2009 to 2012, we prospectively collected and retrospectively analyzed clinical, morphologic, and intraoperative and postoperative data of patients undergoing EVAR for wide-neck AAA at three European vascular surgery units. All patients had computed tomography angiography follow-up of ≥24 months. The early end points were technical success and proximal type I endoleak at 30 days. The midterm end points were type Ia endoleak, freedom from reintervention (FFR), survival, AAA-related mortality, and infrarenal and suprarenal aortic diameter progression. The aortic diameters were measured on three-dimensional workstation center lumen line reconstructions, 1 cm below the lowest renal artery, at the level of the renal arteries, at the superior mesenteric artery, and at the celiac trunk. Preoperative and 24-month aortic diameters were compared by paired t-test. Survival and FFR were evaluated by Kaplan-Meier analysis. During the study period, 118 patients (74 ± 8 years) were enrolled. The mean aneurysm diameter was 61 ± 10 mm. Suprarenal and infrarenal fixation endografts were implanted in 102 (86%) and 16 (14%) patients, respectively. The mean main body oversizing was 17% ± 9%. Technical success rate was 98% (three type Ia endoleaks at 30 days). The mean follow-up was 38 ± 12 months. Fourteen type Ia endoleaks (12%) were detected during follow-up. Survival at 3 years and 5 years was 89% and 70%, respectively. Four deaths (3.4%) were type Ia endoleak related. FFR at 1 year, 3 years, and 5 years was 96%, 83%, and 82%, respectively. Eight reinterventions (7%) were proximal neck related. All infrarenal and suprarenal aortic diameters increased at 24 months. The mean increase was 11% for the lowest renal artery (29.1 ± 1.1 mm preoperatively vs 32.3 ± 4

  18. Endovascular treatment of intracranial aneurysms with Barricade coils: Feasibility, procedural safety, and immediate postoperative anatomical results.

    PubMed

    Zidan, Mohamed; Gawlitza, Matthias; Metaxas, Georgios; Foussier, Cédric; Soize, Sébastien; Pierot, Laurent

    2016-10-01

    The safety of bare platinum coils has been widely described in the literature. This study aimed to report the first series of intracranial aneurysms treated with Barricade bare platinum coils with a comprehensive evaluation of their procedural safety and postprocedural anatomical results. Patients with intracranial aneurysms treated between October 2013 and December 2015 by simple coiling or balloon-assisted coiling with Barricade coils (Blockade Medical, Irvine, California, USA) were prospectively included in a database and retrospectively studied. For all included patients, the patient and aneurysm characteristics, procedural complications, technical issues, postoperative anatomical results, and one-month clinical outcome (modified Rankin Scale) were evaluated by an independent interventional neuroradiologist. Eighty-eight patients harboring 97 aneurysms were included. Procedural complications and technical issues were encountered in 17 and 5 patients (19.3 and 5.7%, respectively), but clinical worsening in only 2 patients (2.2%). There was no treatment-related mortality. After one month, morbidity (mRS≥1) was observed in 19 patients (21.8%), 17 related to subarachnoid hemorrhage (SAH) in patients with ruptured aneurysms (19.4%) and 2 related to thromboembolic events in patients with unruptured aneurysms (2.3%). Nine patients initially presenting with a ruptured aneurysm were deceased at 1 month as a consequence of SAH (10.2%). Adequate occlusion was observed postoperatively in 94.8% of the aneurysms (complete occlusion in 81.4% and residual neck in 13.4%). Endovascular treatment of intracranial aneurysms with Barricade coils is feasible and the demonstrated overall safety results are within the ranges found in the literature for other coils. Immediate anatomical results are satisfying. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent.

    PubMed

    Fang, Chun; Tan, Hua-Qiao; Han, Hong-Jie; Feng, Hao; Xu, Ji-Chong; Yan, Shuo; Nie, Zhi-Yu; Jin, Ling-Jing; Teng, Fei

    2017-10-01

    Intracranial blood blister-like aneurysm (BBA) is a rare type of aneurysm that lacks all layers of the arterial wall. These fragile aneurysms have the propensity to rupture with minimal manipulation, which makes them hazardous and difficult to treat. The present study evaluated the safety and feasibility of endovascular treatment of BBAs with the Willis covered stent. Thirteen patients (7 men and 6 women, age range 28-68 years) who presented with ruptured BBAs and were treated with the Willis covered stent were retrospectively reviewed. Results of the procedures and treatment-related complications were recorded. Angiographic and clinical follow-ups were performed 4-6 months after the procedure. Placement of the covered stent was successful in all patients. Immediate angiography showed complete aneurysm occlusion in 12 patients while one patient showed a mild endoleak. This high rate of aneurysm exclusion ensured the security of postoperative antiplatelet treatment. Occlusion of the ophthalmic artery occurred in two patients and occlusion of the anterior choroidal artery occurred in one patient; however, none of them showed acute or delayed clinical symptoms. Thrombosis, aneurysm rupture, and other complications did not develop in any case. Angiographic follow-up showed complete aneurysm exclusion without aneurysm recurrence in any patients. Only two patients showed asymptomatic mild to moderate in-stent stenosis. All patients had satisfactory clinical outcomes (modified Rankin Scale score ≤1). Willis covered stent implementation may be safe and feasible for BBAs. This strategy might be a promising option for this high-risk type of aneurysm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Fusiform aneurysms of the vertebrobasilar arterial trunk: choice of endovascular methods and therapeutic efficacy.

    PubMed

    Wang, Qihong; Leng, Bing; Song, Donglei; Chen, Gong

    2010-09-01

    Fusiform aneurysms (FUANs) of vertebrobasilar arterial (VBA) trunk are difficult to treat by using current surgical and endovascular techniques. The objective of this study is to compare the efficacy of FUANs of VBA trunk which was treated with various therapeutic modalities including unilateral or bilateral vertebral artery occlusion, trapping of the aneurysm with coils, stent-assistant coiling, or sole stenting. Between 2000 and 2008, 17 patients with FUANs (ranged in size from 8 to 45 mm) of VBA trunk in our hospital underwent endovascular treatment in our hospital. Eleven patients were evaluated by test occlusion with nondetachable silicone balloon or hyperglide balloon, and seven patients in this series passed testing with temporary balloon occlusion, among which four patients showed positive result, and three patients were conducted bilateral VA test occlusion. Finally, nine patients underwent a trapping of the aneurysm by coils, four patients were treated with stent-supported coil embolization, and four patients with nonhemorrhagic FUAN of VBA were treated only by stenting. The average imaging follow-up was 28 months, with a range from 6 to 48 months. Fourteen (82%) had excellent or good outcome, three (17.6%) had a poor outcome, and one (5.8%) died. Management of FUANs of VBA trunk often poses difficult therapeutic problems. In some cases, multiple treatment sessions may be not only safe but also necessary for the effective treatment of these aneurysms to achieve a complete or an acceptable result.

  1. Benchtop quantification of gutter formation and compression of chimney stent grafts in relation to renal flow in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations.

    PubMed

    Boersen, Johannes T; Donselaar, Esme J; Groot Jebbink, Erik; Starreveld, Roeliene; Overeem, Simon P; Slump, Cornelis H; de Vries, Jean-Paul P M; Reijnen, Michel M P J

    2016-12-14

    The chimney technique has been successfully used to treat juxtarenal aortic aneurysms. The two main issues with this technique are gutter formation and chimney graft (CG) compression, which induce a risk for type Ia endoleaks and stent thrombosis, respectively. In this benchtop study, the geometry and renal artery flow of chimney endovascular aneurysm repair configurations were compared with chimney configurations with endovascular aneurysm sealing (ch-EVAS). Seven flow phantoms were constructed, including one control and six chimney endovascular aneurysm repairs (Endurant [Medtronic Inc, Minneapolis, Minn] and AFX [Endologix Inc, Irvine, Calif]) or ch-EVAS (Nellix, Endologix) configurations, combined with either balloon-expandable or self-expanding CGs with an intended higher positioning of the right CG in comparison to the left CG. Geometric analysis was based on measurements at three-dimensional computed tomography angiography and included gutter volume and CG compression, quantified by the ratio between maximal and minimal diameter (D-ratio). In addition, renal artery flow was studied in a physiologic flow model and compared with the control. The average gutter volume was 343.5 ± 142.0 mm(3), with the lowest gutter volume in the EVAS-Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) combination (102.6 mm(3)) and the largest in the AFX-Advanta V12 (Atrium Medical Corporation, Hudson, NH) configuration (559.6 mm(3)). The maximum D-ratio was larger in self-expanding CGs than in balloon-expandable CGs in all configurations (2.02 ± 0.34 vs 1.39 ± 0.13). The CG compression had minimal influence on renal volumetric flow (right, 390.7 ± 29.4 mL/min vs 455.1 mL/min; left, 423.9 ± 28.3 mL/min vs 410.0 mL/min in the control). This study showed that gutter volume was lowest in ch-EVAS in combination with a Viabahn CG. CG compression was lower in configurations with the Advanta V12 than with Viabahn. Renal flow is unrestricted by CG compression

  2. Sideways displacement of the endograft within the aneurysm sac is associated with late adverse events after endovascular aneurysm repair.

    PubMed

    Waasdorp, Evert J; Gorrepati, Madhu L; Rafii, Benjamin Y; de Vries, Jean-Paul P M; Zarins, Christopher K

    2012-04-01

    Previous studies have shown the importance of proximal and distal endograft fixation. There is little information on the middle, unsupported section of endograft within the aneurysm sac. We quantified sideways movement of the endograft within the aneurysm sac and correlated it to late adverse events. Patients who underwent endovascular abdominal aortic aneurysm (AAA) repair with a suprarenal or infrarenal endograft between January 1997 and December 2007 were analyzed for sideways endograft movement. Patients were included if they had a digital preoperative computed tomography angiogram (CTA), a postoperative CTA within 3 months after the index procedure, and at least one follow-up CTA thereafter with a minimal time interval of 6 months. The endograft position within the aneurysm sac was quantitated on cross-sectional images using a fixed vertebral body reference point. Patients with change in endograft position ≥5 mm were placed in the sideways displacement (SD) group and compared with patients with no displacement (ND; <5 mm change in position). The relationship between sideways endograft movement and endovascular aneurysm repair (EVAR)-related complications were noted for AAA rupture, AAA-related death, conversion, secondary procedures, AAA growth (≥5 mm), proximal migration (≥10 mm), and new onset of type I or III endoleaks. The study included 144 patients (mean age, 76 ± 7.6 years). Mean follow-up time was 43 ± 27 months. Fifty patients (35%) had sideways endograft movement ≥5 mm during follow-up. Baseline AAA diameter was larger (SD 60 ± 9 mm vs ND 57 ± 9 mm; P < .05) and proximal and iliac endograft fixation lengths were shorter (SD 18 ± 8 mm vs ND 24 ± 11 mm; P < .05 and SD 35 ± 14 vs ND 42 ± 16 mm; P < .05) in patients with sideways endograft displacement. There was no significant difference between the groups in AAA rupture and AAA-related death (one fatal AAA rupture, ND group). SD patients had a higher surgical conversion rate (10% vs 0

  3. Endovascular Therapeutic Options for Isolated Iliac Aneurysms with a Working Classification

    SciTech Connect

    Fahrni, Markus; Lachat, Mario M; Wildermuth, Simon; Pfammatter, Thomas

    2003-09-15

    The purpose of this paper is to demonstrate a variety of stent-grafting and embolization techniques and describe a new classification for endovascular treatment of isolated iliac artery aneurysms. A total of 19 patients were treated for isolated iliac aneurysms. Depending on the proximal iliac neck and the uni-/bilaterality of common iliac artery aneurysms (CIAA's) the patient may be treated by a tube (Type Ia) or a bifurcated stent-graft (Type Ib) in addition to internal iliac artery embolization. Neck anatomy is also critical in determining therapeutical options for internal iliac artery aneurysms (IIAA's). These are tube stent-grafting plus internal iliac branch embolization (Type IIa), coiling of afferent and efferent internal iliac vessels (Type IIb) and IIAA packing (Type IIc). The average length of stay for these procedures was 3.8 days. During the mean follow-up of 20.9 months, aneurysm size remained unchanged in all but 4 patients. Reinterventions were necessary in option Type Ib (3/8 pat.) and Type Ia (1/7 pat.) due to extender stent-graft migration (n = 2) or reperfusion leaks (n 2). We conclude that Iliac artery aneurysms may be successfully and safely treated by a tailored approach using embolization or a combination of embolization and stent-grafting. Long-term CT imaging follow-up is necessary, particularly in patients treated with bifurcated stent-grafts (Type Ib)

  4. Delayed pan-hypopituitarism as a complication following endovascular treatment of bilateral internal carotid artery aneurysms. A case report and review.

    PubMed

    Hall, Jonathan; Caputo, Carmela; Chung, Carlos; Holt, Michael; Wang, Yi Yuen

    2015-04-01

    Pan-hypopituitarism has been reported in patients who are subsequently found to have a cerebral aneurysm and there have been reports of pituitary dysfunction immediately following both surgical and endovascular treatment. The authors report a rare case of delayed pan-hypopituitarism following endovascular treatment of bilateral internal carotid artery aneurysms with coil embolisation and flow-diverting stents.

  5. Vertebro-basilar junction aneurysms: a single centre experience and meta-analysis of endovascular treatments.

    PubMed

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-12-01

    Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option.

  6. Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

    PubMed Central

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-01-01

    Summary Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option. PMID:25489898

  7. Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm.

    PubMed

    Fontanella, M; Perozzo, P; Ursone, R; Garbossa, D; Bergui, M

    2003-10-01

    After open surgery for ruptured ACoA aneurysms, several patients who have achieved a favourable neurological outcome still exhibit significant cognitive deficits. The aim of this study was to investigate the cognitive performances in patients with ACoA aneurysms submitted to different therapeutic options such as endovascular treatment and surgical clipping. We evaluated 37 consecutive patients in WFNS grade I or II, who underwent an early treatment (within 48 hours) of a bleeding ACoA aneurysm: 20 out of 37 were surgically clipped (group A) and 17 were treated with endovascular coiling (group B). These two groups were compared with 16 patients (group C) with subarachnoid haemorrhage and negative cerebral panangiography and with 18 volunteers (group D) without neurological or psychiatric disorders. All patients were neurologically intact at discharge and were in Glasgow Outcome Scale 1 at 6 months follow-up after SAH. All subjects were tested to assess selective attention, verbal, spatial and logical memory, frontal lobe executive functions, language and intelligence. Depressive symptoms and anxiety were also examined. Selective attention, verbal and spatial memory, and intelligence tests didn't show any significant difference between the patients and the controls. Surgically treated patients showed a significant worse performance on the logical memory and on the frontal lobe executive functions compared to controls, while the endovascular group and the group C (not treated) showed a significant decrease only in the literal fluency score.Moreover, the surgical group showed a significant impairment in using grammatical and syntactical rules to produce sentences. No significant difference was found between the group B, C and controls. Treated patients were not significantly more depressive or anxious than controls. Investigation of neuropsychological deficits can show an impairment, even in patients classified as good outcome by Glasgow Outcome Scale (GOS). The

  8. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    PubMed

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena

    2008-01-01

    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  9. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.

    PubMed

    Lederle, Frank A; Freischlag, Julie A; Kyriakides, Tassos C; Padberg, Frank T; Matsumura, Jon S; Kohler, Ted R; Lin, Peter H; Jean-Claude, Jessie M; Cikrit, Dolores F; Swanson, Kathleen M; Peduzzi, Peter N

    2009-10-14

    Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial. A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008. Elective endovascular (n = 444) or open (n = 437) repair of AAA. Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function. In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the

  10. Resident and fellow experiences after the introduction of endovascular aneurysm repair for abdominal aortic aneurysm

    PubMed Central

    Sachs, Teviah; Schermerhorn, Marc; Pomposelli, Frank; Cotterill, Philip; O’Malley, James; Landon, Bruce

    2015-01-01

    Objectives This study assessed trends in open and endovascular repair (EVAR) of intact and ruptured abdominal aortic aneurysm (AAA) in the Medicare population and evaluated recent trends in AAA repair at vascular fellowship training programs. Methods We identified all Medicare beneficiaries with a diagnosis of AAA who underwent repair or had a primary diagnosis of rupture (1995–2008). Cohorts were compared by type of repair (open vs EVAR) and presentation (intact vs ruptured AAA). Demographics of age, sex, and race were evaluated. We used unique hospital identifier codes to compare trends and 30-day mortality between hospitals that participate in vascular surgery fellowship training and those that do not. American Council on Graduate Medical Education data, only available for the years 1999 to 2008, were further used to better understand the changes in number of EVAR and open repairs of AAA performed each year for vascular fellows and general surgery residents, over time. Results We identified 449,122 patients (76% men), with 376,355 intact AAAs (84%) and 72,767 ruptured AAAs (16%). Mean age was 75.1 years. Use of EVAR for intact AAA rose to from 35% in 2001 to 63% in 2005 and comprised 78% of repairs by 2008. During the same period, the number of ruptured AAAs decreased by 40% overall, with nonoperative ruptured AAAs decreasing by 29% and EVAR increasing to 31% of rupture repairs. Hospitals training vascular fellows were quicker to adopt EVAR (2-year lag time) for intact AAA and had higher rates of EVAR for ruptured AAA (41.1% vs 29.2%; P = .001) than did hospitals without fellows. Mortality rates for open repairs of intact (4.0% vs 5.0%; P = .01) and ruptured AAA (34.1% vs 41.0%; P = .031) were lower at fellowship hospitals. The average number of open AAA repairs performed by vascular fellows dropped 50% (44.1 to 21.6/year) from 1999 to 2008. Conclusions Contrary to the expectation of a plateau, use of EVAR for intact AAA continues to rise at fellowship and

  11. Percutaneous endovascular management of occluded HeRO dialysis access device.

    PubMed

    Vasquez, Julio C; DeLaRosa, Jacob; Leon, Juan J; Rahim, Naeem; Rahim, Fahim

    2010-01-01

    The Hemodialysis Reliable Outflow (HeRO) device is a novel alternative for dialysis access in patients with no suitable veins in the upper extremities. We placed a HeRO device in a 67-year-old woman with end-stage renal disease and 2 months later, it was being used for hemodialysis. After 1 month of uneventful use, the device thrombosed and it was rescued with a percutaneous endovascular approach. The device remains patent 6 months after the intervention.

  12. Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan.

    PubMed

    Morimae, Hirofumi; Maekawa, Takashi; Tamai, Hiroaki; Takahashi, Noriko; Ihara, Tsutomu; Hori, Akihiko; Narita, Hiroshi; Banno, Hiroshi; Kobayashi, Masayoshi; Yamamoto, Kiyohito; Komori, Kimihiro

    2012-01-01

    We conducted this study to compare the cost of open surgical repair (OR) with that of endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA). Between January 2007 and November 2008, 70 patients underwent open repair and 57 patients underwent EVAR. We evaluated the total cost, including that of the Diagnosis Procedure Combination (DPC), that of the surgical procedure, that of materials such as grafts and guide wires, and that of the anesthesia. The mean costs for OR versus EVAR were as follows: DPC, ¥632,370 versus ¥490,050, respectively, which was significant; anesthesia, ¥123,540 versus ¥86,220, respectively (P < 0.05); and materials, ¥257,770 versus ¥2,113,280, respectively (P < 0.05). Thus, the mean total cost was ¥1,825,830 versus ¥3,159,270 for open repair and EVAR, respectively (P < 0.05). New technologies should not only be clinically effective, but also cost effective. EVAR is less invasive clinically, but the cost of endovascular prostheses and other materials remains high.

  13. Early-Dynamic Positron Emission Tomography (PET)/Computed Tomography and PET Angiography for Endoleak Detection After Endovascular Aneurysm Repair.

    PubMed

    Drescher, Robert; Gühne, Falk; Freesmeyer, Martin

    2017-06-01

    To propose a positron emission tomography (PET)/computed tomography (CT) protocol including early-dynamic and late-phase acquisitions to evaluate graft patency and aneurysm diameter, detect endoleaks, and rule out graft or vessel wall inflammation after endovascular aneurysm repair (EVAR) in one examination without intravenous contrast medium. Early-dynamic PET/CT of the endovascular prosthesis is performed for 180 seconds immediately after intravenous injection of F-18-fluorodeoxyglucose. Data are reconstructed in variable time frames (time periods after tracer injection) to visualize the arterial anatomy and are displayed as PET angiography or fused with CT images. Images are evaluated in view of vascular abnormalities, graft configuration, and tracer accumulation in the aneurysm sac. Whole-body PET/CT is performed 90 to 120 minutes after tracer injection. This protocol for early-dynamic PET/CT and PET angiography has the potential to evaluate vascular diseases, including the diagnosis of complications after endovascular procedures.

  14. Early Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Complicated by Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

    PubMed Central

    Manto, Andrea; De Gennaro, Angela; Manzo, Gaetana; Serino, Antonietta; Quaranta, Gaetano; Cancella, Claudia

    2014-01-01

    Summary Aneurysmal subarachnoid hemorrhage (SAH) may be associated with acute cardiopulmonary complications, like neurogenic pulmonary edema (NPE) and Takotsubo-like cardiomyopathy (TCM). These dysfunctions seem to result from a neurogenically induced overstimulation of the sympathetic nervous system through the brain-heart connection and often complicate poor grade aneurysmal SAH. The optimal treatment modality and timing of intervention in this clinical setting have not been established yet. Early endovascular therapy seems to be the fitting treatment in this particular group of patients, in which surgical clipping is often contraindicated due to the added risk of craniotomy. Herein we describe the case of a woman admitted to the emergency department with aneurysmal SAH complicated by NPE-TCM, in which early endovascular coiling was successfully performed. Our case, characterized by a favorable outcome, further supports the evidence that early endovascular treatment should be preferred in this peculiar clinical scenario. PMID:24976204

  15. Early endovascular treatment of aneurysmal subarachnoid hemorrhage complicated by neurogenic pulmonary edema and Takotsubo-like cardiomyopathy.

    PubMed

    Manto, Andrea; De Gennaro, Angela; Manzo, Gaetana; Serino, Antonietta; Quaranta, Gaetano; Cancella, Claudia

    2014-06-01

    Aneurysmal subarachnoid hemorrhage (SAH) may be associated with acute cardiopulmonary complications, like neurogenic pulmonary edema (NPE) and Takotsubo-like cardiomyopathy (TCM). These dysfunctions seem to result from a neurogenically induced overstimulation of the sympathetic nervous system through the brain-heart connection and often complicate poor grade aneurysmal SAH. The optimal treatment modality and timing of intervention in this clinical setting have not been established yet. Early endovascular therapy seems to be the fitting treatment in this particular group of patients, in which surgical clipping is often contraindicated due to the added risk of craniotomy. Herein we describe the case of a woman admitted to the emergency department with aneurysmal SAH complicated by NPE-TCM, in which early endovascular coiling was successfully performed. Our case, characterized by a favorable outcome, further supports the evidence that early endovascular treatment should be preferred in this peculiar clinical scenario.

  16. Deformable Surface Model for the Evaluation of Abdominal Aortic Aneurysms Treated with an Endovascular Sealing System.

    PubMed

    Casciaro, Mariano E; El-Batti, Salma; Chironi, Gilles; Simon, Alain; Mousseaux, Elie; Armentano, Ricardo L; Alsac, Jean-Marc; Craiem, Damian

    2016-05-01

    Rupture of abdominal aortic aneurysms (AAA) is responsible for 1-3% of all deaths among the elderly population in developed countries. A novel endograft proposes an endovascular aneurysm sealing (EVAS) system that isolates the aneurysm wall from blood flow using a polymer-filled endobag that surrounds two balloon-expandable stents. The volume of injected polymer is determined by monitoring the endobag pressure but the final AAA expansion remains unknown. We conceived and developed a fully deformable surface model for the comparison of pre-operative sac lumen size and final endobag size (measured using a follow-up scan) with the volume of injected polymer. Computed tomography images were acquired for eight patients. Aneurysms were manually and automatically segmented twice by the same observer. The injected polymer volume resulted 9% higher than the aneurysm pre-operative lumen size (p < 0.05), and 11% lower than the final follow-up endobag volume (p < 0.01). The automated method required minimal user interaction; it was fast and used a single set of parameters for all subjects. Intra-observer and manual vs. automated variability of measured volumes were 0.35 ± 2.11 and 0.07 ± 3.04 mL, respectively. Deformable surface models were used to quantify AAA size and showed that EVAS system devices tended to expand the sac lumen size.

  17. Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis

    PubMed Central

    Gascou, Grégory; Trévillot, Vincent; Bonafé, Alain; Crampette, Louis; Machi, Paolo

    2015-01-01

    Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency. PMID:26494406

  18. The effect of hemodynamics on the failure of endovascular coiling in cerebral aneurysms

    NASA Astrophysics Data System (ADS)

    Cha, Kyung Se; Lieber, Baruch B.

    2005-11-01

    Today the treatment of intracranial aneurysms with endovascular coils is an established procedure which has several advantages compared to surgical clipping. However, coil compaction with recanalization remains a long term problem and is observed in approximately 50% of large and giant aneurysm cases over a 5-6 year follow-up period. Clinical data suggest that the coil packing density and the location and size of the aneurysm are important parameters in the long term outcome, suggesting that the repeated impulses exerted by the impingement of the pulsatile blood flow on the coil are mainly responsible for coil compaction. To test this hypothesis we will present: 1. patient specific simulations of two different clinical cases having high and low coil compaction risk respectively; 2. a systematic study on the effects of various geometrical parameters (bifurcation angle, ratio of aneurysm neck size to parent vessel diameter) on the magnitude of the total force on the coil, using idealized configurations. In all cases the three-dimensional laminar flow computations have been carried out using an unstructured, finite-element, Navier-Stokes solver. It will be shown that the ratio of aneurysm neck size to parent vessel diameter has the largest influence on the maximum force on the coil, which is less sensitive to the bifurcation angle.

  19. Endovascular Treatment of Wide-Necked Visceral Artery Aneurysms Using the Neurovascular Comaneci Neck-Bridging Device: A Technical Report.

    PubMed

    Maingard, Julian; Kok, Hong Kuan; Phelan, Emma; Logan, Caitriona; Ranatunga, Dinesh; Brooks, Duncan Mark; Chandra, Ronil V; Lee, Michael J; Asadi, Hamed

    2017-06-29

    Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs. We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches. In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation. The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques. Level 4, Technical Report.

  20. Real-Time Magnetic Resonance-Guided Endovascular Repair of Experimental Abdominal Aortic Aneurysm in Swine

    PubMed Central

    Raman, Venkatesh K.; Karmarkar, Parag V.; Guttman, Michael A.; Dick, Alexander J.; Peters, Dana C.; Ozturk, Cengizhan; Pessanha, Breno S. S.; Thompson, Richard B.; Raval, Amish N.; DeSilva, Ranil; Aviles, Ronnier J.; Atalar, Ergin; McVeigh, Elliot R.; Lederman, Robert J.

    2005-01-01

    OBJECTIVES This study tested the hypotheses that endografts can be visualized and navigated in vivo solely under real-time magnetic resonance imaging (rtMRI) guidance to repair experimental abdominal aortic aneurysms (AAA) in swine, and that MRI can provide immediate assessment of endograft apposition and aneurysm exclusion. BACKGROUND Endovascular repair for AAA is limited by endoleak caused by inflow or outflow malapposition. The ability of rtMRI to image soft tissue and flow may improve on X-ray guidance of this procedure. METHODS Infrarenal AAA was created in swine by balloon overstretch. We used one passive commercial endograft, imaged based on metal-induced MRI artifacts, and several types of homemade active endografts, incorporating MRI receiver coils (antennae). Custom interactive rtMRI features included color coding the catheter-antenna signals individually, simultaneous multislice imaging, and real-time three-dimensional rendering. RESULTS Eleven repairs were performed solely using rtMRI, simultaneously depicting the device and soft-tissue pathology during endograft deployment. Active devices proved most useful. Intraprocedural MRI provided anatomic confirmation of stent strut apposition and functional corroboration of aneurysm exclusion and restoration of laminar flow in successful cases. In two cases, there was clear evidence of contrast accumulation in the aneurysm sac, denoting endoleak. CONCLUSIONS Endovascular AAA repair is feasible under rtMRI guidance. Active endografts facilitate device visualization and complement the soft tissue contrast afforded by MRI for precise positioning and deployment. Magnetic resonance imaging also permits immediate post-procedural anatomic and functional evaluation of successful aneurysm exclusion. PMID:15963411

  1. Evaluation of texture for classification of abdominal aortic aneurysm after endovascular repair.

    PubMed

    García, Guillermo; Maiora, Josu; Tapia, Arantxa; De Blas, Mariano

    2012-06-01

    The use of the endovascular prostheses in abdominal aortic aneurysm has proven to be an effective technique to reduce the pressure and rupture risk of aneurysm. Nevertheless, in a long-term perspective, complications such as leaks inside the aneurysm sac (endoleaks) could appear causing a pressure elevation and increasing the danger of rupture consequently. At present, computed tomographic angiography (CTA) is the most common examination for medical surveillance. However, endoleak complications cannot always be detected by visual inspection on CTA scans. The investigation on new techniques to detect endoleaks and analyse their effects on treatment evolution is of great importance for endovascular aneurysm repair (EVAR) technique. The purpose of this work was to evaluate the capability of texture features obtained from the aneurysmatic thrombus CT images to discriminate different types of evolutions caused by endoleaks. The regions of interest (ROIs) from patients with different post-EVAR evolution were extracted by experienced radiologists. Three techniques were applied to each ROI to obtain texture parameters, namely the grey level co-occurrence matrix (GLCM), the grey level run length matrix (GLRLM) and the grey level difference method (GLDM). The results showed that GLCM, GLRLM and GLDM features presented a good discrimination ability to differentiate between favourable or unfavourable evolutions. GLCM was the most efficient in terms of classification accuracy (93.41% ± 0.024) followed by GLRLM (90.17% ± 0.077) and finally by GLDM (81.98% ± 0.045). According to the results, we can consider texture analysis as complementary information to classified abdominal aneurysm evolution after EVAR.

  2. In-Stent Stenosis of Stent Assisted Endovascular Treatment on Intracranial Complex Aneurysms

    PubMed Central

    Yoon, Kyeong-Wook

    2010-01-01

    Objective To introduce the frequency and segment analysis of in-stent stenosis for intracranial stent assisted endovascular treatment on complex aneurysms. Methods A retrospective study was performed in 158 patients who had intracranial complex aneurysms and were treated by endovascular stent application with or without coil embolization. Of these, 102 patients were evaluated with catheter based angiography after 6, 12, and 18 months. Aneurysm location, using stent, time to stenosis, stenosis rate and narrowing segment were analyzed. Results Among follow-up cerebral angiography done in 102 patients, 8 patients (7.8%) were shown an in-stent stenosis. Two patients have unruptured aneurysm and six patients have ruptured one. Number of Neuroform stents were 7 cases (7.5%) and Enterprise stent in 1 case (11.1%). Six patients demonstrated in-stent stenosis at 6 months after stent application and remaining two patients were shown at 12 months, 18 months, respectively. Conclusion In-stent stenosis can be confronted after intracranial stent deployment. In our study, no patient showed symptomatic stenosis and there were no patients who required to further treatment except continuing antiplatets medication. In-stent stenosis has been known to be very few when they are placed into the non-pathologic parent artery during the complex aneurysm treatment, but the authors found that it was apt to happen on follow up angiography. Although the related symptom was not seen in our cases, the luminal narrowing at the stented area may result the untoward hemodynamic event in the specific condition. PMID:21430973

  3. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    SciTech Connect

    Silverberg, Daniel Yalon, Tal; Halak, Moshe

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  4. Results of Endovascular Coil Embolization Treatment for Small (≤ 5 mm) Unruptured Intracranial Aneurysms

    PubMed Central

    Lee, Siwoo; Lee, Yong-Woo; Kim, Hyo-Joon; Kweon, Chang-young

    2016-01-01

    Objective Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. Materials and Methods We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. Results UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. Conclusion The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs. PMID:27847766

  5. Surgeon Custom-Made Iliac Branch Device to Salvage Hypogastric Artery during Endovascular Aneurysm Repair

    PubMed Central

    2014-01-01

    Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications. PMID:25469069

  6. Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Jun, P.; Ko, N.U.; English, J.D.; Dowd, C.F.; Halbach, V.V.; Higashida, R.T.; Lawton, M.T.; Hetts, S.W.

    2014-01-01

    BACKGROUND AND PURPOSE CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases. MATERIALS AND METHODS We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008. RESULTS Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications. CONCLUSIONS Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy. PMID:20616179

  7. Successful endovascular repair of an aneurysm of the ductus diverticulum with a branched stent graft: case report and review of literature.

    PubMed

    Saito, Naritatsu; Kimura, Takeshi; Toma, Masanao; Teragaki, Masakazu; Minaminimura, Hiroyoshi; Kita, Toru; Inoue, Kanji

    2004-12-01

    Aneurysm of the ductus diverticulum rarely has been reported in adults, and the reported aneurysms were treated with conventional open surgery or were diagnosed at autopsy. We report a successful endovascular repair of an aneurysm of the ductus diverticulum with the Inoue branched stent graft. In a 78-year-old woman, an abnormal shadow was noted at the aortopulmonary window on a chest x-ray film. A computed tomography scan demonstrated a 3.8-cm saccular aneurysm, which protruded inferiorly from the distal end of the aortic arch. The aneurysm was considered an aneurysm of the ductus diverticulum, and surgery was required. However, the patient was considered at high risk for respiratory dysfunction with conventional open surgery. Endovascular repair with an Inoue single-branched stent graft was performed with the patient under local anesthesia, successfully and without complication or endoleak. To our knowledge, this is the first report of endovascular treatment of an aneurysm of the ductus diverticulum.

  8. Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms

    PubMed Central

    Mahmoud, M.

    2013-01-01

    Summary Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value. PMID:23472719

  9. Complicated Fenestrated Endovascular Repair of a Pararenal Aortic Aneurysm.

    PubMed

    Kasemi, Holta; Marino, Mario; Di Angelo, Costantino Luca; Fadda, Gian Franco

    2016-04-01

    We report the case of a 77-year-old man treated with a custom-made fenestrated endograft for pararenal aortic aneurysm repair. Fenestrations for the superior mesenteric and both the renal arteries and augmented anterior valley and/or scallop for the celiac trunk were performed. The procedure was complicated by the superior mesenteric artery stent-graft entrapment from the endograft delivery system release wires and total dislodgement into the endograft main body. Superior mesenteric artery restenting and displaced stent-graft removal completed the intervention. Fenestrated-endograft deployment should be performed by a team familiar with the device, deployment system, and bail out solutions.

  10. Postapproval outcomes of juxtarenal aortic aneurysms treated with the Zenith fenestrated endovascular graft.

    PubMed

    Vemuri, Chandu; Oderich, Gustavo S; Lee, Jason T; Farber, Mark A; Fajardo, Andres; Woo, Edward Y; Cayne, Neal; Sanchez, Luis A

    2014-08-01

    The objective of this study was to evaluate postapproval outcomes of patients with juxtarenal aortic aneurysms treated with the Zenith fenestrated endovascular graft (Cook Inc, Bloomington, Ind). We reviewed clinical data of consecutive patients treated with the Zenith fenestrated endovascular graft in the United States at seven institutions with early commercial access from July 2012 to December 2012. Clinical outcomes and compliance to anatomic guidelines were compared with results of the U.S. fenestrated trial (USFT). Fifty-seven patients were treated. There were significantly more (P < .05) patients with coronary artery disease, myocardial infarction, and preoperative renal insufficiency than in the USFT. Thirty-six patients (63.2%) did not meet the USFT anatomic criteria of a >4-mm infrarenal neck, and there were significantly more mesenteric stents (13 vs 0; P < .05) used in this group than in the USFT, reflecting the higher anatomic complexity of these patients. The total operative time was 250.2 ± 14.8 minutes, the fluoroscopy time was 68.9 ± 4.47 minutes, and the average volume of contrast material was 108.6 ± 5.6 mL. Technical success was 100% in regard to aneurysm exclusion, although the left renal fenestration was not able to be aligned in two patients, and one patient had a kinked renal stent that was successfully restented. During this time period, there were a total of 10 endoleaks, of which two were type III and eight were type II. Despite higher rates of comorbidities and more challenging anatomy, early 30-day outcomes of juxtarenal aortic aneurysms treated postapproval with the Zenith fenestrated endovascular graft compare well with USFT data. Future studies are needed to assess durability of this treatment modality as the technology diffuses and data mature. Published by Mosby, Inc.

  11. Endovascular Treatment of Proximal Anastomotic Aneurysms After Aortic Prosthetic Reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n = 1), bifurcated graft (n = 1)]. In one patient an uni iliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  12. Vascular Complications in Lumbar Spinal Surgery: Percutaneous Endovascular Treatment

    SciTech Connect

    Lee, Kyoung Ho; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Shin, Sang Joon; Kang, Heung Sik

    2000-01-15

    Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula.We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.

  13. Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options

    SciTech Connect

    Haslam, J. Elizabeth Hardman, John; Horrocks, Michael; Fay, Dominic

    2009-01-15

    The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

  14. Endovascular aortic repair of a postdissecting thoracoabdominal aneurysm using intraoperative fusion imaging.

    PubMed

    Kaladji, Adrien; Dumenil, Aurélien; Castro, Miguel; Haigron, Pascal; Heautot, Jean-François; Haulon, Stéphan

    2013-04-01

    Computer-aided imaging can aid complex endovascular repair of aortic dissections in locating the narrow true lumen and identifying perfusion of visceral vessels by the true and/or false lumen. Although these anatomic data are available for analysis during planning, they are not readily available during the procedure with conventional imaging systems. We report the use of "fusion imaging" to facilitate the treatment of a postdissection thoracoabdominal aneurysm. The preoperative computer tomographic angiograms were processed, and the true and the false lumens were individually color labeled. These data were then superimposed on the fluoroscopic images in order to facilitate deployment of a fenestrated endograft.

  15. Delayed renal dysfunction and flash pulmonary edema post endovascular abdominal aneurysm repair.

    PubMed

    Carron, Pierre-Louis; Piliero, Nicolas; Heitz, Morgane; Kribs, Marc; Rodière, Mathieu; Jousse, Patrick; Gunther-Calvino, Silvia; Thony, Frédéric

    2016-04-01

    After endovascular aortic repair (EVAR), the deterioration in long-term renal function is probably multifactorial. Preoperative renal failure is an independent risk factor. Postoperative renal dysfunction can be associated with inadvertent renal artery occlusion, renal artery complications as stenosis, plaque dislodgement, or dissection. Ischemic nephropathy can accelerate hypertension and circulatory congestion. We report a case of coverage of the renal arteries symptomatic with flash pulmonary edema and renal failure 15 months after EVAR, suggesting a delayed endograft migration. The patient had complete resolution of symptoms and renal function after renal artery stenting with placement between endograft and aneurysm to the left renal artery.

  16. Molded Parallel Endografts for Branch Vessel Preservation during Endovascular Aneurysm Repair in Challenging Anatomy

    PubMed Central

    Minion, David

    2012-01-01

    Parallel endografts (also known as snorkels or chimneys) are a proposed strategy for increasing the applicability of endovascular repair to aneurysms involving branch vessels. One major disadvantage of this strategy is the imperfect nature of seal inherent to having multiple side-by-side endografts. In this article, the use of odd-shaped parallel endografts to facilitate apposition and improve seal is proposed and a technique to mold a round stent graft into an “eye” shape using balloons is described. PMID:23730134

  17. Successful transfemoral aortic valve implantation through aortic stent graft after endovascular repair of abdominal aortic aneurysm.

    PubMed

    Kawashima, Hideyuki; Watanabe, Yusuke; Kozuma, Ken

    2017-04-01

    The patient was a 91-year-old woman presenting with severe aortic valve stenosis. Pre-procedural computed tomography scan revealed a 45-mm abdominal aortic aneurysm (AAA). Transfemoral transcatheter aortic valve implantation (TF-TAVI) was performed after endovascular aortic repair (EVAR) of the AAA. The 23-mm Edwards Sapien XT system passed through the aortic stent graft smoothly. This is the first case report showing that successful TF-TAVI can be performed through a prior abdominal aortic stent graft. TF-TAVI after EVAR of AAA is a feasible option for patients with extremely poor access.

  18. Acute Remodeling of an Adjoining Aneurysm after Endovascular Treatment of a Ruptured Splanchnic Arterial Aneurysm: A Case of Clinically Diagnosed Segmental Arterial Mediolysis

    PubMed Central

    Hoshina, Katsuyuki; Sasaki, Hiroki; Hosaka, Akihiro; Yamamoto, Kota; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2012-01-01

    A 61-year-old woman with multiple splanchnic arterial aneurysms (SAAs) was transferred to our hospital in a state of shock. She underwent coil embolization under the diagnosis of ruptured pancreaticoduodenal artery aneurysm. Follow-up computed tomography performed 2 weeks later showed rapid enlargement of a gastric artery aneurysm, and she underwent an additional embolization. Atherosclerotic, inflammatory or hereditary causes were excluded, and the patient was clinically diagnosed with segmental arterial mediolysis accompanied by multiple SAAs, one of which showed acute remodeling after endovascular treatment. PMID:23641269

  19. Acute remodeling of an adjoining aneurysm after endovascular treatment of a ruptured splanchnic arterial aneurysm: a case of clinically diagnosed segmental arterial mediolysis.

    PubMed

    Nishikawa, Yoshitaka; Hoshina, Katsuyuki; Sasaki, Hiroki; Hosaka, Akihiro; Yamamoto, Kota; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2012-01-01

    A 61-year-old woman with multiple splanchnic arterial aneurysms (SAAs) was transferred to our hospital in a state of shock. She underwent coil embolization under the diagnosis of ruptured pancreaticoduodenal artery aneurysm. Follow-up computed tomography performed 2 weeks later showed rapid enlargement of a gastric artery aneurysm, and she underwent an additional embolization. Atherosclerotic, inflammatory or hereditary causes were excluded, and the patient was clinically diagnosed with segmental arterial mediolysis accompanied by multiple SAAs, one of which showed acute remodeling after endovascular treatment.

  20. Endovascular treatment of intracranial aneurysms in the flow diverter era: frequency of use and results in a consecutive series of 550 treatments in a single centre.

    PubMed

    van Rooij, Willem Jan; Bechan, Ratna S; Peluso, Jo P; Sluzewski, Menno

    2014-01-01

    Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques.

  1. Ruptured Internal Iliac Artery Aneurysm: Staged Emergency Endovascular Treatment in the Interventional Radiology Suite

    SciTech Connect

    Kelckhoven, Bas-Jeroen van Bruijninckx, Boy M. A.; Knippenberg, Bob; Overhagen, Hans van

    2007-07-15

    Ruptured aneurysms of the internal iliac artery (IIA) are rare and challenging to treat surgically. Due to their anatomic location they are difficult to operate on and perioperative morbidity is high. An endovascular approach can be helpful. We recently treated a patient with a ruptured IIA aneurysm in the interventional radiology suite with embolization of the side-branch of the IIA and placement of a covered stent in the ipsilateral common and external iliac arteries. A suitable stent-graft was not available initially and had to be brought in from elsewhere. An angioplasty balloon was temporarily placed across the ostium of the IIA to obtain hemostasis. Two hours later, the procedure was finished by placing the stent-graft.

  2. Treatment of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysms: Transcaval Approach

    SciTech Connect

    Mansueto, Giancarlo Cenzi, Daniela; D'Onofrio, Mirko; Petrella, Enrico; Gumbs, Andrew A.; Mucelli, Roberto Pozzi

    2005-06-15

    The purpose of the note is to describe a new technique for type II endoleak treatment, using an alternative approach through femoral venous access. Three patients who developed type II endoleak after endovascular repair of abdominal aortic aneurysm were treated with direct transcaval puncture and embolization inside the aneurysm sac. The detailed technique is described. All patients were treated without any complications and discharged 48 hours after the treatment. At 1 month follow-up the computed tomograph scan did not show a recurrence of a type II endoleak. The management of patients with type II endoleak is a controversial issue and different techniques have been proposed. We suggest an alternative technique for type II endoleak treatment. The feasibility and the advantages of this approach can offer new possibilities for the diagnosis as well as for the treatment of this complication.

  3. Thromboembolic complications after endovascular repair of abdominal aortic aneurysm with neck thrombus.

    PubMed

    Shintani, Tsunehiro; Mitsuoka, Hiroshi; Atsuta, Kouji; Saitou, Takaaki; Higashi, Shigeki

    2013-04-01

    To evaluate outcomes after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with neck thrombus. We retrospectively reviewed patients who underwent EVAR for AAA at our institution from 2007 to 2011. Patients with ruptured AAA, chronic renal failure, or hostile neck characteristics other than thrombus were excluded. Patients were divided into 2 groups: group T (with neck thrombus) and group N (without neck thrombus). We compared complications and mid-term outcomes. There were no differences in success rates between the groups, but there were higher rates of thromboembolic complications such as distal embolization (20% vs 0%, P = .02) and renal dysfunction (36.8% vs 11.1%, P = .03) in group T than in group N. Suprarenal thrombus and suprarenal fixation in the presence of suprarenal thrombus were associated with postoperative renal dysfunction (P = .01). The EVAR for AAA with neck thrombus is associated with thromboembolic complications.

  4. Ischemic skin ulceration complicating glue embolization of type II endoleak after endovascular aneurysm repair.

    PubMed

    Bailey, Marc A; McPherson, Simon J; Troxler, Max A; Peach, A Howard S; Patel, Jai V; Scott, D Julian A

    2011-02-01

    The optimal treatment for type II endoleaks remains unclear. The present report describes a case of ischemic skin ulceration after glue embolization of a type II endoleak with challenging access in a multiply comorbid 82-year-old woman with an expanding aneurysm sac 3 years after endovascular aneurysm repair. Embolization was performed from a proximal position with an n-butyl cyanoacrylate/Ethiodol mixture to allow flow into the endoleak because direct sac puncture was hazardous. One week after intervention, an eschar, which progressed to superficial necrosis as a result of partial nontarget delivery of sclerosant, developed over the left iliac crest. The eschar was self-limiting, with complete resolution by 6 months. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  5. Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair

    PubMed Central

    Chen, Hamilton; Tafazoli, Sharwin

    2015-01-01

    Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure. PMID:25650247

  6. AngioLab--a software tool for morphological analysis and endovascular treatment planning of intracranial aneurysms.

    PubMed

    Larrabide, Ignacio; Villa-Uriol, Maria-Cruz; Cárdenes, Rubén; Barbarito, Valeria; Carotenuto, Luigi; Geers, Arjan J; Morales, Hernán G; Pozo, José M; Mazzeo, Marco D; Bogunović, Hrvoje; Omedas, Pedro; Riccobene, Chiara; Macho, Juan M; Frangi, Alejandro F

    2012-11-01

    Determining whether and how an intracranial aneurysm should be treated is a tough decision that clinicians face everyday. Emerging computational tools could help clinicians analyze clinical data and make these decisions. AngioLab is a single graphical user interface, developed on top of the open source framework GIMIAS, that integrates some of the latest image analysis and computational modeling tools for intracranial aneurysms. Two workflows are available: Advanced Morphological Analysis (AMA) and Endovascular Treatment Planning (ETP). AngioLab has been evaluated by a total of 62 clinicians, who considered the information provided by AngioLab relevant and meaningful. They acknowledged the emerging need of these type of tools and the potential impact they might have on the clinical decision-making process.

  7. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    PubMed Central

    Mu, Shi-Qing; Yang, Xin-Jian; Li, You-Xiang; Jiang, Chu-Han; Wu, Zhong-Xue

    2015-01-01

    Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3–6 months or 12–18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis. PMID:26168833

  8. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note.

    PubMed

    Mu, Shi-Qing; Yang, Xin-Jian; Li, You-Xiang; Jiang, Chu-Han; Wu, Zhong-Xue

    2015-07-20

    The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique. We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  9. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial.

    PubMed

    Stroupe, Kevin T; Lederle, Frank A; Matsumura, Jon S; Kyriakides, Tassos C; Jonk, Yvonne C; Ge, Ling; Freischlag, Julie A

    2012-10-01

    This study was conducted to determine the costs and comparative cost-effectiveness of two methods of abdominal aortic aneurysm (AAA) repair in the Open Versus Endovascular Repair (OVER) Veterans Affairs (VA) Cooperative Study, a multicenter randomized trial of 881 patients. The primary outcomes of this analysis were mean total health care cost per life-year and per quality-adjusted life-year (QALY) from randomization to 2 years after. QALYs were calculated from EuroQol (EQ)-5D questionnaires collected at baseline and annually. Health care utilization data were obtained directly from patients and from national VA and Medicare data sources. VA costs were obtained from national VA sources using methods previously developed by the VA Health Economics Resource Center. Costs for non-VA care were determined from Medicare claims data or billing data from the patient's health care providers. After 2 years of follow-up, mean life-years were 1.78 in the endovascular repair group and 1.74 in the open repair group (difference, 0.04; 95% confidence interval [CI], -0.03 to 0.09; P = .29). Mean QALYs were 1.462 in the endovascular group and 1.461 in the open group (difference adjusting for baseline EQ-5D score, 0.006; 95% CI, -0.038 to 0.052; P = .78). Mean graft costs were higher in the endovascular group ($14,052 vs $1363; P < .001), but length of stay was shorter (5.0 vs 10.5 days; P < .001), resulting in a lower mean cost of the hospital admission for the AAA procedure in the endovascular repair group of $37,068 vs $42,970 (difference, -$5901; 95% CI, -$12,135 to -$821; P = .04). After 2 years, total health care costs remained lower in the endovascular group, but the difference was no longer significant (-$5019; 95% CI, -$16,720 to $4928; P = .35). The probability of endovascular repair being less costly and more effective was 70.9% for life-years and 51.4% for QALYs. In this multicenter randomized trial, endovascular AAA repair resulted in lower cost and better survival than

  10. Clinical Outcome of Paraclinoid Internal Carotid Artery Aneurysms After Microsurgical Neck Clipping in Comparison with Endovascular Embolization

    PubMed Central

    Bae, Dong-Hyun; Won, Yu-Deok; Choi, Kyu-Sun; Cheong, Jin-Hwan; Yi, Hyeong-Joong; Kim, Choong-Hyun

    2014-01-01

    Objective Because of the complex anatomical association among vascular, dural, and bony structures, paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. We studied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgical clipping in comparison with endovascular coiling. Materials and Methods Between January 2008 and December 2012, we treated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascular coiling. Preoperative neurologic status and postoperative outcome were evaluated using the Glasgow coma scale (GCS) and the modified Rankin scale (mRS). Postoperative hydrocephalus and vasospasm were reviewed using the patients' medical charts. Results Most patients were in good clinical condition before the operations and had good treatment outcomes. Clinical vasospasm was observed after the operation in five patients, and hydrocephalus occurred in six patients. No statistically significant difference regarding aneurysm size, sex, GCS score, H-H grade, and mRS was observed between the surgical clipping group and the endovascular coiling group. In addition, the treatment results and complications did not show statistically significant difference in either group. Conclusion Surgical occlusion of paraclinoid ICA aneurysms is difficult; however, no significant differences were observed in the treatment results or complications when compared with coil embolization. In particular, use of an adequate surgical technique may lead to better outcomes than those for coil embolization in the treatment of large and/or wide-neck paraclinoid ICA aneurysms. PMID:25340024

  11. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study*

    PubMed Central

    Cantador, Alex Aparecido; Siqueira, Daniel Emílio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fábio Hüsemann; Guillaumon, Ana Terezinha

    2016-01-01

    Objective To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. PMID:27777476

  12. The Endovascular Preprocedural Run Through and Brief: A Simple Intervention to Reduce Radiation Dose and Contrast Load in Endovascular Aneurysm Repair.

    PubMed

    Stansfield, Tim; Parker, Richard; Masson, Neil; Lewis, David

    2016-05-01

    To assess the impact of a quality assured planning and sizing process and the endovascular team briefing (preprocedure run through and brief - PRTB) on the delivery of endovascular aneurysm repair (EVAR), in Edinburgh. Prospective observational study, comparing parameters before and after the intervention. Prospectively collected database recording infrarenal aneurysms treated with EVAR performed from January 2007 to April 2014 at our institution. The total screening time, iodinated contrast volume used, radiation dose, endovascular training opportunities, and hospital length of stay were recorded. A comparison before (January 2007 to November 2011) and after (December 2011 to April 2014) the introduction of the PRTB was made for each of these variables. Multiple linear regression analysis was performed to account for the learning effect. In this study, 61 EVAR cases were performed prior to and 44 EVAR cases after the introduction of the PRTB. Univariate Mann-Whitney tests suggested a significant difference between before PRTB introduction and after PRTB introduction on all outcome variables except procedure time. Multiple linear regression analysis results showed a statistically significant improvement in outcomes after the change point for all outcomes except for radiation dose. Endovascular training opportunities were realized in 12/61 (20%) before compared to 42/44 cases (95%) after PRTB introduction. By introducing rigorous quality assurance and utilizing the principles of crew resource management to the EVAR process, it is possible to reduce screening times, contrast use, hospital length of stay, and improve endovascular training opportunities. © The Author(s) 2016.

  13. In-situ laser fenestration of endovascular stent-graft in abdominal aortic aneurysm repair (EVAR)

    NASA Astrophysics Data System (ADS)

    Micheletti, Filippo; Pini, Roberto; Piazza, Roberta; Ferrari, Vincenzo; Condino, Sara; Rossi, Francesca

    2017-02-01

    Endovascular abdominal aortic aneurysms repair (EVAR) involves the minimally invasive implantation of a stent-graft within the aorta to exclude the aneurysm from the circulation thus preventing its rupture. The feasibility of such operation is highly dependent on the aorta morphology and in general the presence of one/both renal arteries emerging from the aneurysm is the absolute limit for the implantation of a standard stent-graft. Consequently, classical intervention methods involve the implantation of a custom-made graft with fenestrations, leading to extremely complicated surgeries with high risks for the patient and high costs. Recent techniques introduced the use of standard grafts (i.e. without fenestrations) in association with mechanical in-situ fenestration, but this procedure is limited principally by the brittleness and low stability of the environment, in addition to the difficulty of controlling the guidance of the endovascular tools due to the temporarily block of the blood flow. In this work we propose an innovative EVAR strategy, which involves in-situ fenestration with a fiber guided laser tool, controlled via an electromagnetic navigation system. The fiber is sensorized to be tracked by means of the driving system and, using a 3D model of the patient anatomy, the surgeon can drive the fiber to the aneurysm, where the stent has been previously released, to realize the proper fenestration(s). The design and construction of the catheter laser tool will be presented, togheter with preliminary fenestration tests on graft-materials, including the effects due to the presence of blood and tissues.

  14. Hybrid endovascular repair of thoracic aortic aneurysm in a patient with Behçet's disease following right to left carotid-carotid bypass grafting.

    PubMed

    Hong, Soonchang; Park, Han Ki; Shim, Won-Heum; Youn, Young-Nam

    2011-03-01

    Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behçet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.

  15. Endovascular Repair of Abdominal Aortic Aneurysms: Analysis of Aneurysm Volumetric Changes at Mid-Term Follow-Up

    SciTech Connect

    Bargellini, Irene Cioni, Roberto; Petruzzi, Pasquale; Pratali, Alessandro; Napoli, Vinicio; Vignali, Claudio; Ferrari, Mauro; Bartolozzi, Carlo

    2005-05-15

    Purpose. To evaluate the volumetric changes in abdominal aortic aneurysms (AAA) after endovascular AAA repair (EVAR) in 24 months of follow-up. Methods. We evaluated the volume modifications in 63 consecutive patients after EVAR. All patients underwent strict duplex ultrasound and computed tomography angiography (CTA) follow-up; when complications were suspected, digital subtraction angiography was also performed. CTA datasets at 1, 6, 12, and 24 months were post-processed through semiautomatic segmentation, to isolate the aneurysmal sac and calculate its volume. Maximum transverse diameters (Dmax) were also obtained in the true axial plane, Presence and type of endoleak (EL) were recorded. A statistical analysis was performed to assess the degree of volume change, correlation with diameter modifications, and significance of the volume increase with respect to ELs. Results. Mean reconstruction time was 7 min. Mean volume reduction rates were 6.5%, 8%, and 9.6% at 6, 12, and 24 months follow-up, respectively. Mean Dmax reduction rates were 4.2%, 6.7%, and 12%; correlation with volumes was poor (r = 0.73-0.81). ELs were found in 19 patients and were more frequent (p = 0.04) in patients with higher preprocedural Dmax, The accuracies of volume changes in predicting ELs ranged between 74.6% and 84.1% and were higher than those of Dmax modifications. The strongest independent predictor of EL was a volume change at 6 months {<=}0.3% (p = 0.005), although 6 of 19 (32%) patients with EL showed no significant AAA enlargement, whereas in 6 of 44 (14%) patients without EL the aneurysm enlarged. Conclusion. The lack of volume decrease in the aneurysm of at least 0.3% at 6 months follow-up indicates the need for closer surveillance, and has a higher predictive accuracy for an endoleak than Dmax.

  16. Measuring of Abdominal Aortic Aneurysm with Three-Dimensional Computed Tomography Reconstruction before Endovascular Aortic Aneurysm Repair

    PubMed Central

    Chung, Yoona; Joh, Jin Hyun; Park, Ho-Chul

    2017-01-01

    Purpose Conventional computed tomography (CT) is the gold standard method for case planning for endovascular aortic aneurysm repair (EVAR). However, aortography with a marking catheter is needed for measuring the actual length of an aneurysm. With advances in imaging technology, a 3-dimensional (3D) workstation can obviate the need for the aortography. The objective of this study was to determine whether a 3D workstation could obviate the need for aortography for EVAR. Materials and Methods One vascular surgeon and 1 interventional radiologist retrospectively assessed axial CT scans and reformatted the 3D CT scans by using the iNtuition workstation (TeraRecon Inc., San Mateo, CA, USA) for 25 patients who underwent EVAR. Four measurements of diameter and length were obtained from each modality. The actual length of an aneurysm for the proper graft was decided by 2 observers by reviewing the aortography with a marking catheter. Results The measurements from the 2 modalities were reproducible with intraobserver correlation coefficients of 0.89 to 1.0 for conventional CT and 0.98 to 1.0 for 3D workstation. Interobserver correlation coefficients were 0.29 to 0.95 for conventional CT and 0.85 to 0.99 for the 3D workstation. The length of the aneurysm for proper main graft coincided in 18 and 14 patients according to the conventional CT scan and in 21 and 18 patients according to the 3D workstation, respectively. Conclusion The interobserver agreement in planning EVAR was significantly better with the iNtuition 3D workstation. But aortography with a marking catheter may still be needed for selecting the proper graft. PMID:28377909

  17. Thoracoabdominal aortic replacement for Crawford extent II aneurysm after thoracic endovascular aortic repair

    PubMed Central

    Hu, Haiou; Zheng, Tie; Zhu, Junming; Liu, Yongmin; Qi, Ruidong

    2017-01-01

    Background The surgical treatment of Crawford extent II aneurysms after thoracic endovascular aortic repair (TEVAR) remains challenging, because of the need to remove the failed endograft and the complexity of the aortic reconstruction. We retrospectively reviewed our experience with surgical management of Crawford extent II aneurysms after TEVAR using thoracoabdominal aortic replacement (TAAR). Methods Eleven patients (10 males, 1 female) with Crawford extent II aneurysm after TEVAR were treated with TAAR between August 2012 and May 2015. The indications included: diameter >5.0 cm; persistent pain; size increase >0.5 cm/year; and no suitable landing zone for re-TEVAR. Five patients underwent surgery under deep hypothermic cardiac arrest, two under mild hypothermic cardiopulmonary bypass, and four under direct aortic cross-clamping under normothermia. Two patients had Marfan syndrome. Results There were no in-hospital deaths. Continuous renal replacement therapy was required in three patients. One patient needed re-intubation, and two patients had prolonged intubation (>72 h). One patient sustained paraplegia after surgery but recovered during follow-up. Cerebrospinal fluid drainage were used in four patients (3 immediately in the operation room, and 1 in the intensive care unit when the patient suffered paraplegia). One patient died during follow-up. Conclusions TAAR represents a feasible option for the treatment of Crawford extent II aneurysms after TEVAR, with acceptable surgical risks and favorable results. PMID:28203407

  18. Ruptured intracranial tubercular infectious aneurysm secondary to a tuberculoma and its endovascular management.

    PubMed

    Saraf, R; Limaye, U

    2013-04-01

    Tuberculosis remains to be an endemic infectious disease in developing countries. With the increasing incidence of HIV and AIDS, there is further increase in the incidence of tuberculosis. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients. Central nervous system tuberculosis may present as tuberculoma, cerebral abscess or tuberculous meningitis (TBM). Vasculitis secondary to TBM can cause infarcts and rarely aneurysm formation. In TBM there is a thick, gelatinous exudate around the sylvian fissures, basal cisterns. There is a border zone reaction occurring in the surrounding brain tissue. Inflammatory changes occur in the vessel wall of the arteries bathed in the exudate leading to narrowing of the lumen or occlusion by thrombus formation. The vessels at the base of the brain are most severely affected, including the internal carotid artery, proximal middle cerebral artery and perforating vessels of the basal ganglion. In these cases, the infection probably spreads from the adventitia towards the internal elastic lamina, weakening the vessel wall, with subsequent formation of an infectious aneurysm. Intracranial tuberculomas are space-occupying masses of granulomatous tissue that result from haematogenous spread from a distant focus of tuberculous infection. In endemic regions, tuberculomas account for as many as 50% of all intracranial space-occupying lesions. Inflammation in the vessels surrounding the tuberculoma may lead to formation of aneurysms. This case report illustrates an unusual case of intracranial tuberculomas complicated by intralesional haemorrhage due to an infective tubercular aneurysm in its vicinity. The endovascular treatment of these infectious aneurysms is safe, effective and durable. To the best of our knowledge, this is the first case report of a tuberculoma having intracranial haemorrhage on anti-tubercular treatment due to an infectious aneurysm developing in an artery in the

  19. Outcomes of Endovascular Repair for Abdominal Aortic Aneurysms: A Nationwide Survey in Japan.

    PubMed

    Hoshina, Katsuyuki; Ishimaru, Shin; Sasabuchi, Yusuke; Yasunaga, Hideo; Komori, Kimihiro

    2017-09-06

    To analyze data on patients treated with a bifurcated stent graft for abdominal aortic aneurysm (AAA). The Japan Committee for Stentgraft Management (JACSM) was established in 2007 to manage the safety of endovascular aortic aneurysm repair (EVAR) in Japan. The JACSM registry includes detailed anatomical and clinical data of all patients who undergo stent graft insertion in Japan. Among 51,380 patients treated with bifurcated stent graft for AAA, we identified 38,008 eligible patients (excluding those with rupture or insufficient data). The analyzed factors included age, sex, comorbidities, AAA pathology and etiology, aneurysm and neck diameters, 7 anti-instructions for use (IFU) factors, and endoleaks at hospital discharge. The endpoints were death, adverse events, sac dilatation (≥5 mm), and reintervention. The rates of intraoperative and in-hospital mortality were 0.08% and 1.07%, respectively. Infectious aneurysm and pseudo-aneurysm were associated with overall survival and reintervention. Older age, large aneurysm diameter, and all types of persistent endoleaks were strong predictors of adverse events, sac dilatation, and reintervention. Comorbid cerebrovascular disease, renal dysfunction, and respiratory disorders were also risk factors. In total, 47.6% of patients violated the IFU; among the anti-IFU factors assessed, poor access and severe neck calcification were strong risk factors for mortality, reintervention, and adverse events. The sac dilatation rate at 5 years was 23.3%. Although the analysis included EVAR with poor anatomy, the perioperative mortality rate was acceptable compared with that in previous large population studies.

  20. Automatic detection of selective arterial devices for advanced visualization during abdominal aortic aneurysm endovascular repair.

    PubMed

    Lessard, Simon; Kauffmann, Claude; Pfister, Marcus; Cloutier, Guy; Thérasse, Éric; de Guise, Jacques A; Soulez, Gilles

    2015-10-01

    Here we address the automatic segmentation of endovascular devices used in the endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) that deform vascular tissues. Using this approach, the vascular structure is automatically reshaped solving the issue of misregistration observed on 2D/3D image fusion for EVAR guidance. The endovascular devices we considered are the graduated pigtail catheter (PC) used for contrast injection and the stent-graft delivery device (DD). The segmentation of the DD was enhanced using an asymmetric Frangi filter. The segmented geometries were then analysed using their specific features to remove artefacts. The radiopaque markers of the PC were enhanced using a fusion of Hessian and newly introduced gradient norm shift filters. Extensive experiments were performed using a database of images taken during 28 AAA-EVAR interventions. This dataset was divided into two parts: the first half was used to optimize parameters and the second to compile performances using optimal values obtained. The radiopaque markers of the PC were detected with a sensitivity of 88.3% and a positive predictive value (PPV) of 96%. The PC can therefore be positioned with a majority of its markers localized while the artefacts were all located inside the vessel lumen. The major parts of the DD, the dilatator tip and the pusher surfaces, were detected accurately with a sensitivity of 85.9% and a PPV of 88.7%. The less visible part of the DD, the stent enclosed within the sheath, was segmented with a sensitivity of 63.4% because the radiopacity of this region is low and uneven. The centreline of the DD in this stent region was alternatively traced within a 0.74 mm mean error. The automatic segmentation of endovascular devices during EVAR is feasible and accurate; it could be useful to perform elastic registration of the vascular lumen during endovascular repair. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  1. [Percutaneous Endovascular Aortic Repair with Local Anesthesia - One Day Surgery].

    PubMed

    Sousa, Joel; Brandão, Daniel; Barreto, Paulo; Ferreira, Joana; Almeida Lopes, José; Mansilha, Armando

    2016-06-01

    Introdução: Avaliar os resultados do tratamento endovascular do aneurisma da aorta abdominal (EVAR) por via percutânea e anestesia local, segundo o conceito de one day surgery.Material e Métodos: Análise retrospetiva, unicêntrica dos doentes com doença aneurismática aorto-ilíaca, consecutivamente submetidos a tratamento endovascular do aneurisma da aorta abdominal por via percutânea (pEVAR) pela técnica de Preclose, seguindo critérios de ambulatorização com pernoita após o procedimento. O sucesso técnico, exclusão do saco aneurismático, endoleak, reintervenção e tempo de internamento foram avaliados.Resultados: Vinte doentes consecutivos (todos homens, idade média 74,65 anos) foram tratados por pEVAR e anestesia local, dos quais 95% (19) apresentavam aneurisma da aorta abdominal e 5% (1) aneurisma da artéria ilíaca comum. Todos os implantes foram realizados com sucesso, com uma taxa de endoleak inicial de 10% (2), à custa de um endoleak 1a corrigido intraoperatoriamente com sucesso, e um endoleak 2a diagnosticado na primeira angio-tomografia computorizada pós-operatória, que selou espontaneamente no controlo aos 6 meses. O sucesso técnico inicial do encerramento percutâneo foi de 97,5%, com um caso reportado de pseudo-aneurisma femoral, corrigido posteriormente por injeção percutânea de trombina. A mediana de internamento foi de 1 dia [1-10], com follow-up médio de 11,4 meses [1-36]. A reintervenção e mortalidade são de 0% no período descrito. Conclusão: O tratamento ambulatório do aneurisma da aorta abdominal por via endovascular com acesso percutâneo segundo o nosso modelo de one day surgery é inovador, seguro e eficaz, respeitando os critérios de seleção.

  2. The Impact of Endovascular Treatment on Isolated Iliac Artery Aneurysm Treatment and Mortality

    PubMed Central

    Buck, Dominique B.; Bensley, Rodney P.; Darling, Jeremy; Curran, Thomas; McCallum, John C.; Moll, Frans L.; van Herwaarden, Joost A.; Schermerhorn, Marc L.

    2015-01-01

    Objective Isolated Iliac artery aneurysms are rare, but potentially fatal. The impact of recent trends in the utilization of endovascular iliac aneurysm repair (EVIR) on isolated iliac artery aneurysm-associated mortality is unknown. Methods We identified all patients with a primary diagnosis of iliac artery aneurysm in the NIS from 1988 to 2011. We examined trends in management (open vs. EVIR, elective and urgent) and overall isolated iliac artery aneurysm related deaths (with or without repair). We compared in-hospital mortality and complications for the subgroup of patients undergoing elective open and EVIR from 2000-2011. Results We identified 33,161 patients undergoing isolated iliac artery aneurysm repair from 1988-2011: of which there were 9,016 EVIR and 4,933 open elective repairs from 2000-2011. Total repairs increased after introduction of EVIR from 28 to 71 per 10M US population (P<.001). EVIR surpassed open repair in 2003. Total isolated iliac artery aneurysm-related deaths, due to rupture or elective repair, decreased after the introduction of EVIR (4.4 to 2.3 per 10M US population, P<.001). However, urgent admissions have not decreased over this time period (15 to 15 procedures per 10M US population, P=0.30). Among elective repairs after 2000, EVIR patients were older (72.4 vs. 69.4 years, P=0.002) and were more likely to have a history of prior MI (14.0% vs. 11.3%, P<.001) and renal failure (7.2% vs. 3.6%, P<.001). Open repair had significantly higher in-hospital mortality (1.8% vs. 0.5%, P<0.001) and complications (17.9% vs. 6.7%, P<0.001), and a longer length of stay (6.7 vs. 2.3 days, P<0.001). Conclusions Treatment of isolated iliac artery aneurysm has increased since the introduction of EVIR and is associated with lower perioperative mortality, despite a higher burden of comorbid illness. Decreasing iliac artery aneurysm-attributable in-hospital deaths are likely related primarily to lower elective mortality with EVIR rather than rupture

  3. Preservation of hypogastric flow and control of iliac aneurysm size in the treatment of aortoiliac aneurysms using the Nellix EndoVascular Aneurysm Sealing endograft.

    PubMed

    Krievins, Dainis K; Savlovskis, Janis; Holden, Andrew H; Kisis, Kaspars; Hill, Andrew A; Gedins, Marcis; Ezite, Natalija; Zarins, Christopher K

    2016-11-01

    The purpose of this study was to determine the long-term effectiveness of endovascular aneurysm sealing (EVAS) in the treatment of complex aortoiliac aneurysms with preservation of hypogastric artery flow. We reviewed all patients with abdominal aortic aneurysms (AAAs) and common iliac aneurysms (CIAs) enrolled and treated in prospective studies of EVAS using the Nellix endograft (Endologix, Irvine, Calif) at two centers from 2008 to 2014. Patients with 1 year or more of computed tomography follow-up underwent quantitative morphometric assessment by two independent vascular radiologists blinded to clinical outcome results. Hypogastric patency and CIA diameter changes over time were assessed and compared in three treatment groups: totally excluded CIA, partially excluded CIA, and untreated CIA. Among 125 patients with EVAS, 68 patients (mean age, 75 ± 8 years; 79% men) had both AAA (mean diameter, 55.8 ± 2.0 mm) and CIA (median diameter, 23.4; interquartile range, 21.3-27.0 mm), with bilateral CIAs in 33 patients. Treatment of 101 CIAs included complete CIA exclusion in 40 (39.6%), partial CIA exclusion in 33 (32.7%), and no CIA treatment in 28 (27.7%), with successful AAA exclusion in all patients. Internal iliac flow was preserved in all 122 hypogastric arteries that were patent before treatment (14 hypogastric arteries were occluded at baseline). During the 5-year follow-up period (median follow-up, 24.7 months; range, 11.5-61.7 months), three patients required secondary treatment with hypogastric occlusion and graft extension to the external iliac. Thus, internal iliac flow was maintained in 98% of at-risk hypogastric arteries. There were no aneurysm-related clinical events, except for the three secondary treatments. Totally excluded iliac aneurysms did not change in diameter over time (P = .85), whereas untreated CIAs enlarged at a rate of 0.16 mm/y (95% confidence interval, 0.09-0.23; P < .0001). Partially excluded CIAs enlarged at a higher rate

  4. Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm

    PubMed Central

    Kaçar, Emre; Nas, Ömer Fatih; Erdoğan, Cüneyt; Hakyemez, Bahattin

    2015-01-01

    PURPOSE We aimed to evaluate the safety and effectiveness of single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. METHODS Hospital database was screened for patients who underwent single-stage endovascular treatment between February 2008 and June 2013 and seven patients were identified. The procedures included unilateral carotid artery stenting (CAS) (n=4), bilateral CAS (n=2), and proximal left subclavian artery stenting (n=1) along with ipsilateral intracranial aneurysm treatment (n=7). The mean internal carotid artery stenosis was 81.6% (range, 70%–95%), and the subclavian artery stenosis was 90%. All aneurysms were unruptured. The mean aneurysm diameter was 7.7 mm (range, 5–13 mm). The aneurysms were ipsilateral to the internal carotid artery stenosis (internal carotid artery aneurysm) in five patients, and in the anterior communicating artery in one patient. The patient with subclavian artery stenosis had a fenestration aneurysm in the proximal basilar artery. Stenting of the extracranial large vessel stenosis was performed before aneurysm treatment in all patients. In two patients who underwent bilateral CAS, the contralateral carotid artery stenosis, which had no aneurysm distally, was treated initially. RESULTS There were no procedure-related complications or technical failure. The mean clinical follow-up period was 18 months (range, 9–34 months). One patient who underwent unilateral CAS experienced contralateral transient ischemic attack during the clinical follow-up. There was no restenosis on six-month follow-up angiograms, and all aneurysms were adequately occluded. CONCLUSION A single-stage procedure appears to be feasible for treatment of patients with severe extracranial large vessel stenosis and concomitant ipsilateral intracranial aneurysm. PMID:26359875

  5. Endovascular Treatment of a Superior Mesenteric Artery Aneurysm Secondary to Behcet's Disease with Onyx (Ethylene Vinyl Alcohol Copolymer)

    SciTech Connect

    Gueven, Koray Rozanes, Izzet; Kayabali, Murat; Minareci, Ozenc

    2009-01-15

    Behcet's disease is a complex multisystemic chronic inflammatory disease that is characterized by oral and genital aphtous ulcers and vasculitis. Aneurysms of major arteries are the most important cause of mortality in Behcet's disease. Four patients with superior mesenteric artery (SMA) aneurysms related to Behcet's disease have been reported in the literature. We report here the first successful endovascular treatment of a giant, wide-necked SMA aneurysm secondary to Behcet's disease. We performed a balloon-assisted embolization technique using ethylene vinyl alcohol copolymer (Onyx, ev3, Irvine, CA, USA). There were no signs of recurrence during 2-year follow-up.

  6. The impact of endovascular aneurysm repair on mortality for elective abdominal aortic aneurysm repair in England and the United States.

    PubMed

    Karthikesalingam, Alan; Holt, Peter J; Vidal-Diez, Alberto; Bahia, Sandeep S; Patterson, Benjamin O; Hinchliffe, Robert J; Thompson, Matthew M

    2016-08-01

    Procedural mortality is of paramount importance for patients undergoing elective abdominal aortic aneurysm (AAA) repair. Previous comparative studies have demonstrated international differences in the care of ruptured AAA. This study compared the use of endovascular aneurysm repair (EVAR) and in-hospital mortality for elective AAA repair in England and the United States. The English Hospital Episode Statistics and the U.S. Nationwide Inpatient Sample (NIS) were interrogated for elective AAA repair from 2005 to 2010. In-hospital mortality and the use of EVAR were analyzed separately for each health care system, after within-country risk adjustment for age, gender, year, and an accepted national comorbidity index. The study included 21,272 patients with AAA in England, of whom 86.61% were male, with median (interquartile range) age of 74 (69-79) years. There were 196,113 AAA patients in the United States, of whom 76.14% were male, with median (interquartile range) age of 73 (67-78) years. In-hospital mortality was greater in England (4.09% vs 1.96 %; P < .01) and EVAR less common (37.33% vs 64.36%; P < .01). These observations persisted in age- and gender-matched comparison. In both countries, lower mortality and greater use of EVAR were seen in centers performing greater numbers of AAA repairs per annum. In England, lower mortality and greater use of EVAR were seen in teaching hospitals with larger bed capacity. In-hospital survival and the uptake of EVAR are lower in England than in the United States. In both countries, mortality was lowest in high-caseload centers performing a greater proportion of cases with endovascular repair. These common factors suggest strategies for improving outcomes for patients requiring elective AAA repair. Copyright © 2016. Published by Elsevier Inc.

  7. Totally Percutaneous Access Using Perclose Proglide for Endovascular Treatment of Aortic Diseases

    PubMed Central

    Saadi, Eduardo Keller; Saadi, Marina; Saadi, Rodrigo; Tagliari, Ana Paula; Mastella, Bernardo

    2017-01-01

    Objective To evaluate our experience following the introduction of a percutaneous program for endovascular treatment of aortic diseases using Perclose Proglide® assessing efficacy, complications and identification of potential risk factors that could predict failure or major access site complications. Methods A retrospective cohort study during a two-year period was performed. All the patients submitted to totally percutaneous endovascular repair (PEVAR) of aortic diseases and transcatheter aortic valve implantation since we started the total percutaneous approach with the preclosure technique from November 2013 to December 2015 were included in the study. The primary endpoint was major ipsilateral access complication, defined according to PEVAR trial. Results In a cohort of 123 patients, immediate technical success was obtained in 121 (98.37%) patients, with only two (0.82%) cases in 242 vascular access sites that required intervention immediately after the procedure. Pairwise comparisons revealed increased major access complication among patients with >50% common femoral artery (CFA) calcification vs. none (P=0.004) and > 50% CFA calcification vs. < 50% CFA calcification (P=0.002). Small artery diameter (<6.5 mm) also increased major access complication compared to bigger diameters (> 6.5 mm) (P=0.027). Conclusion The preclosure technique with two Perclose Proglide® for PEVAR is safe and effective. Complications occur more often in patients with unfavorable access site anatomy and the success rate can be improved with proper patient selection.

  8. Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model.

    PubMed

    Kono, Kenichi; Shintani, Aki; Okada, Hideo; Terada, Tomoaki

    2013-01-01

    Silicone models of cerebral aneurysms are used for evaluation of devices, training, or hemodynamic studies. We report preoperative simulations of endovascular treatment for a case with an unruptured wide-neck aneurysm of the anterior communicating artery using a patient-specific silicone model. Using a rapid prototyping system, we created a silicone model based on the vascular image obtained by three-dimensional rotational angiogram. The aneurysm and vessels formed a cavity in the silicone block model. We performed endovascular simulations using several difference devices and attempted possible methods for coil embolization. We designed treatment strategies based on the simulations and performed balloon-assisted coil embolization of the aneurysm. The simulations were especially useful in navigation of a microcatheter by planning the shape of its tip beforehand. There was one significant difference between the silicone model simulations and actual treatment: the shape of the vessel in the silicone block model was not changed by insertion of a catheter or guidewire. This is the first study to describe preoperative endovascular simulations using a patient-specific silicone model. Our methods of creating a patient-specific model are relatively simple and easy. Although this is a single case, we demonstrate that the simulations are feasible and helpful for designing a treatment strategy and safe manipulation of endovascular devices by experiencing their behavior before actual treatment.

  9. Internal iliac coverage during endovascular repair of abdominal aortic aneurysms is a safe option: A preliminary study.

    PubMed

    Kansal, Vinay; Jetty, Prasad; Kubelik, Dalibor; Hajjar, George; Hill, Andrew; Brandys, Tim; Nagpal, Sudhir

    2017-02-01

    Endovascular aneurysm repairs lacking suitable common iliac artery landing zones occasionally require graft limb extension into the external iliac artery, covering the internal iliac artery origin. The purpose of this study was to assess incidence of type II endoleak following simple coverage of internal iliac artery without embolization during endovascular aneurysm repair. Three hundred eighty-nine endovascular aneurysm repairs performed by a single surgeon (2004-2015) were reviewed. Twenty-seven patients underwent simple internal iliac artery coverage. Type II endoleak was assessed from operative reports and follow-up computed tomography imaging. No patient suffered type II endoleak from a covered internal iliac artery in post-operative computed tomography scans. Follow-up ranged from 0.5 to 9 years. No severe pelvic ischemic complications were observed. In conclusion, for selected cases internal iliac artery coverage without embolization is a safe alternative to embolization in endovascular aneurysm repairs, where the graft must be extended into the external iliac artery.

  10. The "open branch" technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm.

    PubMed

    Krajcer, Zvonimir; Echeverria, Angela

    2016-03-01

    Spinal cord ischemia (SCI) has been one of the most concerning complications after surgical and endovascular thoracoabdominal aortic aneurysm repair "Open Branch" is an innovative technique to reduce the incidence of SCI Further studies in a larger number of patients with varying pathologies are needed to confirm the advantages of this technique.

  11. Anatomic and procedural determinants of fluoroscopy time during elective endovascular aortic aneurysm repair.

    PubMed

    Ruz, Ricardo; Lee, Kevin; Power, Adam H; DeRose, Guy; Forbes, Thomas L; Dubois, Luc

    2016-02-01

    To identify both the procedural and anatomic factors which determine duration of fluoroscopy during elective endovascular aortic aneurysm repair (EVAR). We retrospectively analyzed our prospectively maintained EVAR database for the relationship between fluoroscopy time and both procedural (type of graft, configuration, number of components, surgeon) and anatomic factors reflective of aneurysm complexity (15 variables). A total of 128 patients underwent elective EVAR with a mean fluoroscopy time of 5.7 ± 3.4 min. The type of grafts used consisted of 41 (32%) Zenith, 85 (66.4%) Endurant and 2 (1.6%) Anaconda, with 105 (82%) being bifurcated and 23 (18%) being aorto-uni-iliac (AUI) in configuration. Both the surgeon performing the procedure (p = 0.001) and graft configuration (bifurcated vs. AUI, p = 0.03) were found to be predictive of fluoroscopy time; while procedural and anatomic variables were not. The surgeon's efficiency in the use of fluoroscopy during EVAR is the most important determinant of total fluoroscopy time. Anatomic complexity, make of device, and number of components inserted have minimal impact on duration of fluoroscopy. An endovascular surgeon's ability to curtail fluoroscopy duration is the key component in minimizing radiation exposure to both the surgical team and the patient. © The Author(s) 2015.

  12. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

    PubMed Central

    Roy, David; Kauffmann, Claude; Delorme, Sébastien; Lerouge, Sophie; Cloutier, Guy; Soulez, Gilles

    2012-01-01

    The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts. PMID:22997538

  13. Endovascular Treatment of Huge Dissecting Aneurysms Involving the Basilar Artery

    PubMed Central

    Yang, X.; Mu, S.; Lv, M.; Li, L.; Wu, Z.

    2007-01-01

    Summary Dissecting aneurysms involving the basilar artery (BA) are lesions with significant morbidity and mortality. Their management is controversial and often difficult. There is no generally approved strategy. Two cases of huge dissections involving the BA presented with subarachnoid hemorrhage in one case and mass effect in both cases. The dissection of case 1 involved the upper two thirds of the BA distal to the anterior inferior cerebellar arteries (AICA). Another dissection of case 2 involved the bilateral vertebral arteries (VA) distal to bilateral PICA and extended to upper third of the BA. After making a basket with coils inside the pseudoaneursym, proximal dissection was totally occluded in case 1. Dissection on the bilateral VA distal to the bilateral PICA and proximal BA was occluded in case 2 with a small residual dissection on the left VA. Case 1 had an excellent recovery with a durable image and clinical result. But recanalization and regrowth occurred in case 2, which might have originated from the residual dissection on the left VA, induced acute mass effect and sudden coma six weeks after the initial treatment. The residual and regrown dissection had to be occluded in a second intervention. The patient died two days later. BA occlusion is safe and efficient for dissections involving the BA as in our case and the literature. Proximal occlusion might be enough for huge and long lesions like ours. It seems that completely dense packing of proximal dissection is the key point to prevent recanalization. PMID:20566106

  14. Endovascular Management of Ruptured Abdominal Aortic Aneurysms: An 8-year Single-Centre Experience

    SciTech Connect

    Gerassimidis, Thomas S.; Karkos, Christos D. Karamanos, Dimitrios G.; Papazoglou, Konstantinos O.; Papadimitriou, Dimitrios N.; Demiropoulos, Filippos P.; Malkotsis, Dimitrios P.; Kamparoudis, Apostolos G.

    2009-03-15

    We aimed to review our experience with the endovascular treatment of ruptured abdominal aortic aneurysm (RAAA). During an 8-year period, 69 patients with a RAAA presented to our department; 67 underwent assessment by computed axial tomography, and 2 died on arrival before any evaluation was possible. A total of 42 patients (63%) were suitable for stent-grafting, and all but 1 (c-arm failure) proceeded to endovascular repair. Of these, 27 underwent surgery with local anaesthesia; 3 did so under general anaesthesia; and a further 11 procedures were commenced with the patient under local anaesthesia and then converted to general anaesthesia. A total of 28 bifurcated and 14 aorto-uni-iliac stent-grafts were implanted. Aortic occlusion balloons were used in 2 (5%) patients. The in-hospital and the 30-day mortality rates were 36% and 41%, respectively. After surgery, 21 complications were encountered in 17 patients. Two patients required reintervention during their hospital stay (1 type I endoleak and 1 limb occlusion). During the follow-up (median 730 days [range 90 to 580 days]), the 1-year and 5-year cumulative survival probabilities were 53% (SE 7.9%) and 50% (SE 8.0%), respectively. Three reinterventions were necessary during follow-up (2 type I endoleaks and 1 graft occlusion). We conclude that endovascular treatment is feasible in the emergency setting, and the early experience is promising. Whether such an approach is superior to open surgery remains to be determined.

  15. Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures.

    PubMed

    Proust, François; Debono, Bertrand; Hannequin, Didier; Gerardin, Emmanuel; Clavier, Erick; Langlois, Olivier; Fréger, Pierre

    2003-07-01

    Endovascular and surgical treatment must be clearly defined in the management of anterior communicating artery (ACoA) aneurysms. In this study the authors report their recent experience in using a combined surgical and endovascular team approach for ACoA aneurysms, and compare these results with those obtained during an earlier period in which surgical treatment was used alone. Morbidity and mortality rates, causes of unfavorable outcomes, and morphological results were also assessed. The prospective study included 223 patients who were divided into three groups: Group A (83 microsurgically treated patients, 1990-1995); Group B (103 microsurgically treated patients, 1996-2000); and Group C (37 patients treated with Guglielmi Detachable Coil [GDC] embolization, 1996-2000). Depending on the direction in which the aneurysm fundus projected, the authors attempted to apply microsurgical treatment to Type 1 aneurysms (located in front of the axis formed by the pericallosal arteries). They proposed the most adapted procedure for Type 2 aneurysms (located behind the axis of the pericallosal arteries) after discussion with the neurovascular team, depending on the physiological status of the patient, the treatment risk, and the size of the aneurysm neck. In accordance with the classification of Hunt and Hess, the authors designated those patients with unruptured aneurysms (Grade 0) and some patients with ruptured aneurysms (Grades I-III) as having good preoperative grades. Patients with Grade IV or V hemorrhages were designated as having poor preoperative grades. By performing routine angiography and computerized tomography scanning, the causes of unfavorable outcome (Glasgow Outcome Scale [GOS] score < 5) and the morphological results (complete or incomplete occlusion) were analyzed. Overall, the clinical outcome was excellent (GOS Score 5) in 65% of patients, good (GOS Score 4) in 9.4%, fair (GOS Score 3) in 11.6%, poor (GOS Score 2) in 3.6%, and fatal in 10.3% (GOS Score

  16. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    SciTech Connect

    Zanchetta, Mario Rigatelli, Gianluca; Pedon, Luigi; Zennaro, Marco; Ronsivalle, Salvatore; Maiolino, Pietro

    2003-09-15

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 {+-} 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.

  17. Results of Open and Endovascular Abdominal Aortic Aneurysm Repair According to the E-PASS Score

    PubMed Central

    Menezes, Fábio Hüsemann; Ferrarezi, Bárbara; de Souza, Moisés Amâncio; Cosme, Susyanne Lavor; Molinari, Giovani José Dal Poggetto

    2016-01-01

    Introduction: Endovascular repair (EVAR) of abdominal aortic aneurysm has become the standard of care due to a lower 30-day mortality, a lower morbidity, shorter hospital stay and a quicker recovery. The role of open repair (OR) and to whom this type of operation should be offered is subject to discussion. Objective: To present a single center experience on the repair of abdominal aortic aneurysm, comparing the results of open and endovascular repairs. Methods: Retrospective cross-sectional observational study including 286 patients submitted to OR and 91 patients submitted to EVAR. The mean follow-up for the OR group was 66 months and for the EVAR group was 39 months. Results: The overall mortality was 11.89% for OR and 7.69% for EVAR (P=0.263), EVAR presented a death relative risk of 0.647. It was also found a lower intraoperative bleeding for EVAR (OR=1417.48±1180.42 mL versus EVAR=597.80±488.81 mL, P<0.0002) and a shorter operative time for endovascular repair (OR=4.40±1.08 hours versus EVAR=3.58±1.26 hours, P<0.003). The postoperative complications presented no statistical difference between groups (OR=29.03% versus EVAR=25.27%, P=0.35). Conclusion: EVAR presents a better short term outcome than OR in all classes of physiologic risk. In order to train future vascular surgeons on OR, only young and healthy patients, who carry a very low risk of adverse events, should be selected, aiming at the long term durability of the procedure. PMID:27074271

  18. Endovascular Treatment of a Dissected Celiac Trunk Aneurysm Complicated with Consequent Pseudoaneurysm: Primary Treatment and Treatment Relapse after 5 Years

    PubMed Central

    Giurazza, Francesco; Silvestre, Mattia; Cervo, Amedeo; Maglione, Franco

    2015-01-01

    We report on an asymptomatic 56-year-old male with incidental diagnosis of celiac trunk aneurysm, diagnosed during an ultrasound scan performed to control polycystic kidney disease. The CT scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; finally we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success. Five years later he came back to our department for an aneurysm relapse in the common hepatic artery. We performed a second endovascular approach with a superselective catheterization of the pancreaticoduodenal arcade in order to exclude the lesion with Onyx and microcoils. Nowadays the patient is in good clinical conditions. Endovascular approach is a valuable method to treat visceral aneurysms; however, long-term imaging follow-up is essential to monitor the risk of relapse. PMID:26124975

  19. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm – Adequate Access is Essential for Success – Case Report

    PubMed Central

    Tkalčić, Lovro; Budiselić, Berislav; Kovačević, Miljenko; Knežević, Siniša; Kovačić, Slavica; Miletić, Damir; Tomulić, Vjekoslav; Kuhelj, Dimitrij

    2017-01-01

    Summary Background An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother’s autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Case Report Self-expandable, covered stent (Bard, Fluency®) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX®) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Conclusions Endovascular management of SMAA proved to be safe and efficient. The “access from above” is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications. PMID

  20. Clinical, Microbiologic, and Outcome Analysis of Mycotic Aortic Aneurysm: The Role of Endovascular Repair

    PubMed Central

    Huang, Yao-Kuang; Chen, Chyi-Liang; Lu, Ming-Shian; Tsai, Feng-Chun; Lin, Pyng-Ling; Wu, Chih-Hsiung

    2014-01-01

    Abstract Background: Mycotic aortic aneurysm (MAA) is an infrequent but devastating form of vascular disease. Methods: We conducted a retrospective cohort study at a major medical center to identify independent risk factors for MAA and to provide opinions about treating it. The study population consisted of 43 patients who had had 44 MAAs over a period of 15 y. Results: All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%). Conclusions: Shock is a risk factor for operative mortality. Misdiagnosis and treatment of MAA as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis, and Salmonella serogroup C-associated bacteremia are risk factors for aneurysm-related death. Endovascular repair should be considered as an alternative option to the open repair of MAA. PMID:24800865

  1. Rare use of twin Solitaire® stents in the double waffle-cone technique for endovascular treatment of a wide-necked bifurcation aneurysm.

    PubMed

    Nas, Omer Fatih; Kacar, Emre; Kaya, Ahmet; Erdogan, Cuneyt; Hakyemez, Bahattin

    2015-04-01

    Endovascular treatment of wide-necked bifurcation aneurysms may be challenging. The waffle-cone technique can be used in these aneurysms in case of acute angulation between parent artery and distal artery of the aneurysm. Solitaire® stent (Ev3, Irvine, CA, USA) has the significant advantage of mitigating the potential complication risks. This study reports the second case in the literature in which endovascular treatment of a wide-necked bifurcation aneurysm with the double waffle-cone technique by using twin Solitaire® stents proved to be successful. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

    PubMed

    2015-08-14

    To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. ISRCTN 48334791. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  3. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

    PubMed Central

    Braithwaite, Bruce; Cheshire, Nicholas J.; Greenhalgh, Roger M.; Grieve, Richard; Hassan, Tajek B.; Hinchliffe, Robert; Howell, Simon; Moore, Fionna; Nicholson, Anthony A.; Soong, Chee V.; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Heatley, Francine; Anjum, Aisha; Kalinowska, Gosia; Sweeting, Michael J.; Thompson, Simon G.; Gomes, Manuel; Grieve, Richard; Powell, Janet T.; Ashleigh, Ray; Gomes, Manuel; Greenhalgh, Roger M.; Grieve, Richard; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Roberts, Ian; Bell, Peter R. F.; Cheetham, Anne; Stephany, Jenny; Warlow, Charles; Lamont, Peter; Moss, Jonathan; Tijssen, Jan; Braithwaite, Bruce; Nicholson, Anthony A.; Thompson, Matthew; Ashleigh, Ray; Thompson, Luke; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Thompson, Matt M.; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Ashleigh, Ray; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timothy; El-Tahir, Amin; Asquith, John; Cavanagh, Steve; Dubois, Luc; Forbes, Thomas L.; Ashworth, Emily; Baker, Sara; Barakat, Hashem; Brady, Claire; Brown, Joanne; Bufton, Christine; Chance, Tina; Chrisopoulou, Angela; Cockell, Marie; Croucher, Andrea; Dabee, Leela; Dewhirst, Nikki; Evans, Jo; Gibson, Andy; Gorst, Siobhan; Gough, Moira; Graves, Lynne; Griffin, Michelle; Hatfield, Josie; Hogg, Florence; Howard, Susannah; Hughes, Cían; Metcalfe, David; Lapworth, Michelle; Massey, Ian; Novick, Teresa; Owen, Gareth; Parr, Noala; Pintar, David; Spencer, Sarah; Thomson, Claire; Thunder, Orla; Wallace, Tom; Ward, Sue; Wealleans, Vera; Wilson, Lesley; Woods, Janet; Zheng, Ting

    2015-01-01

    Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI −0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. Clinical trial registration ISRCTN 48334791. PMID:25855369

  4. The establishment of endovascular aneurysm coiling at a neurovascular unit: report of experience during early years.

    PubMed

    Norbäck, O; Gál, G; Johansson, M; Solander, S; Tovi, M; Persson, L; Ronne-Engström, E; Enblad, P

    2005-02-01

    The treatment of cerebral aneurysms is changing from surgical clipping to endovascular coiling (EVC) in many neurovascular centres. The aim of this study was to evaluate the technical results and clinical outcome at 6 months in a consecutive series of subarachnoid hemorrhage (SAH) patients treated with EVC, in a situation when the EVC had been established very rapidly as the first line of treatment at a neurovascular centre. The patient material comprised 239 SAH patients (155 women and 84 men, mean age 55 years, age range 16-81) allocated to EVC as the first line of treatment in the acute stage (within 3 weeks of rupture) between September 1996 and December 2000. Clinical grade on admission was Hunt & Hess (H&H) I and II in 42%, H&H III in 25% and H&H grade IV and V in 33% of the patients. The aneurysm was located in the anterior circulation in 82% of the cases. EVC was performed on days 0-3 in 77% of the cases. EVC of the target aneurysm was able to be completed in 222 patients (93%). Complete occlusion was achieved in 126 patients (53%). Procedural complications occurred in 39 patients (16%). Favourable clinical outcome was observed in 57%, severe disability in 28% and poor outcome in 14% of the patients. Favourable outcome was achieved in 77% of H&H I and II patients and in 43% of H&H III-V patients. The multivariate logistic regression analysis revealed that younger age, good neurological grade on admission, absence of intracerebral hematoma and intraventricular hematoma respectively, ICA-PcomA aneurysm location, later treatment and absence of complications were significant predictors of favourable outcome. After interventional training and installation of the X-ray system, the introduction and establishment of EVC at a neurovascular unit can be done in a short period of time and with favourable results. Future studies must concentrate on identifying factors of importance for the choice of interventional or surgical therapy. The results of this study indicate

  5. Concomitant Persistent Atelectasis following TEVAR Due to a Descending Aortic Aneurysm: Hybrid Endovascular Repair and ECMO Therapy.

    PubMed

    Yavuz, Sadan; Arikan, Ali Ahmet; Ozbudak, Ersan; İrkil, Serhat; Hosten, Tulay; Gumustas, Sevtap; Berki, Kamil Turan

    2015-10-28

    Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Symptoms are usually due to sudden expansion of the aneurysm, which can cause a vague pain in the back, or sometimes a sharp pain that may denote the presence of impending rupture. Other symptoms are related to pressure on adjacent structures, such as pressure on the bronchus that can cause respiratory distress, or pressure on the laryngeal nerve causing vocal hoarseness. Pressure on the esophagus can cause difficulty in swallowing. Currently, open surgery and thoracic endovascular aneurysm repair (TEVAR) are the choices of treatment for descending thoracic aneurysms (DTA). The decision to intervene on a DTA depends on its size, location, rate of growth and symptoms, and the overall medical condition of the patient. The indications for TEVAR should not differ from those for open surgery and typically include aneurysms larger than 6 cm in diameter. Saccular and symptomatic aneurysms are often repaired at a smaller size. It is also suggested that aneurysms with a growth rate more than 1 cm per year, or 0.5 cm in 6 months should be considered for early repair.Despite the close proximity of the aorta and left main bronchus, atelectasis caused by thoracic aortic aneurysms is rare. We review the case report of a patient with concomitant persistent left pulmonary atelectasis causing acute respiratory distress due to complete compression of the left main bronchus after TEVAR of a descending thoracic aortic aneurysm.

  6. Successful endovascular treatment of a growing megadolichoectasic vertebrobasilar artery aneurysm by flow diversion using the "diverter-in-stent" technique.

    PubMed

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Itshayek, Eyal

    2012-01-01

    Giant dolichoectatic and fusiform aneurysms of the vertebrobasilar artery are among the most difficult and dangerous aneurysms to treat. Conservative management may be reasonable in asymptomatic elderly patients. Nevertheless, due to the frequent presence of mass effect on the brainstem and the risks of thromboembolic events and rupture, these aneurysms often demand treatment rather than observation. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment. When dealing with giant, progressively enlarging symptomatic aneurysms, more limited therapeutic alternatives are available. The authors present a case of a growing megadolichoectatic vertebrobasilar artery aneurysm causing major disability due to increasing mass effect in a 51-year-old man. The aneurysm was treated with flow diversion by placing multiple telescoped stents and diverters ("diverter-in-stent" technique), achieving thrombosis of the aneurysm and reduction of the mass effect on the brainstem, with neurological improvement. The successful clinical and angiographic results observed in our case of giant dolichoectasic vertebrobasilar aneurysm contribute to the literature on giant aneurysms treated by means of flow diversion. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Computer-supported diagnosis for endotension cases in endovascular aortic aneurysm repair evolution.

    PubMed

    García, G; Tapia, A; De Blas, M

    2014-06-01

    An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images. The system is based on the extraction of texture features from post-EVAR thrombus aneurysm samples and on posterior classification. Three conventional texture-analysis methods, namely the gray level co-occurrence matrix (GLCM), the gray level run length matrix (GLRLM), the gray level difference method (GLDM), and a new method proposed by the authors, the run length matrix of local co-occurrence matrices (RLMLCM), were applied to each sample. Several classification schemes were experimentally evaluated. The ensembles of a k-nearest neighbor (k-NN), a multilayer perceptron neural network (MLP-NN), and a support vector machine (SVM) classifier fed with a reduced version of texture features resulted in a better performance (Az=94.35±0.30), as compared to the classification performance of the other alternatives. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Type II Endoleak After Endovascular Repair of Abdominal Aortic Aneurysm: Effectiveness of Embolization

    SciTech Connect

    Nevala, Terhi; Biancari, Fausto; Manninen, Hannu; Aho, Pekka-Sakari; Matsi, Pekka; Maekinen, Kimmo; Roth, Wolf-Dieter; Yloenen, Kari; Lepaentalo, Mauri; Peraelae, Jukka

    2010-04-15

    The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 {+-} 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak without enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.

  9. Systematic review of mortality risk prediction models in the era of endovascular abdominal aortic aneurysm surgery.

    PubMed

    Lijftogt, N; Luijnenburg, T W F; Vahl, A C; Wilschut, E D; Leijdekkers, V J; Fiocco, M F; Wouters, M W J M; Hamming, J F

    2017-07-01

    The introduction of endovascular aneurysm repair (EVAR) has reduced perioperative mortality after abdominal aortic aneurysm (AAA) surgery. The objective of this systematic review was to assess existing mortality risk prediction models, and identify which are most useful for patients undergoing AAA repair by either EVAR or open surgical repair. A systematic search of the literature was conducted for perioperative mortality risk prediction models for patients with AAA published since 2006. PRISMA guidelines were used; quality was appraised, and data were extracted and interpreted following the CHARMS guidelines. Some 3903 studies were identified, of which 27 were selected. A total of 13 risk prediction models have been developed and directly validated. Most models were based on a UK or US population. The best performing models regarding both applicability and discrimination were the perioperative British Aneurysm Repair score (C-statistic 0·83) and the preoperative Vascular Biochemistry and Haematology Outcome Model (C-statistic 0·85), but both lacked substantial external validation. Mortality risk prediction in AAA surgery has been modelled extensively, but many of these models are weak methodologically and have highly variable performance across different populations. New models are unlikely to be helpful; instead case-mix correction should be modelled and adapted to the population of interest using the relevant mortality predictors. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  10. Open versus endovascular stent graft repair for abdominal aortic aneurysms: an historical view.

    PubMed

    Rutherford, Robert B

    2012-03-01

    Development of endovascular abdominal aortic aneurysms repair (EVAR), now in its 4th decade, has involved at least 16 different devices, not counting major modifications of some, only 4 of which have emerged from clinical trials and gained US Food and Drug Administration approval. The main impetus behind EVAR has been its potential for significantly reducing procedural mortality and morbidity, but it was also expected to speed recovery and reduce costs through decreased use of hospital resources. At the outset, EVAR was touted as a better alternative to OPEN in high-risk patients with large abdominal aortic aneurysms, and to "watchful waiting" (periodic ultrasound surveillance) for those with small abdominal aortic aneurysms. This new technology has evoked a mixed response with enthusiasts and detractors debating its pros and cons. Bias and conflict of interest exist on both sides. This review will attempt to present a balanced review of the development and current status of this controversial competition between EVAR and OPEN, comparing them in terms of the following key considerations: mortality and morbidity, complications, failure modes and durability, and costs.

  11. Diagnostic Accuracy of Somatosensory Evoked Potential Monitoring in Evaluating Neurological Complications During Endovascular Aneurysm Treatment.

    PubMed

    Ares, William J; Grandhi, Ramesh M; Panczykowski, David M; Weiner, Gregory M; Thirumala, Parthasarathy; Habeych, Miguel E; Crammond, Donald J; Horowitz, Michael B; Jankowitz, Brian T; Jadhav, Ashutosh; Jovin, Tudor G; Ducruet, Andrew F; Balzer, Jeffrey

    2017-06-14

    Somatosensory evoked potential (SSEP) monitoring is used extensively for early detection and prevention of neurological complications in patients undergoing many different neurosurgical procedures. However, the predictive ability of SSEP monitoring during endovascular treatment of cerebral aneurysms is not well detailed. To evaluate the performance of intraoperative SSEP in the prediction postprocedural neurological deficits (PPNDs) after coil embolization of intracranial aneurysms. This population-based cohort study included patients ≥18 years of age undergoing intracranial aneurysm embolization with concurrent SSEP monitoring between January 2006 and August 2012. The ability of SSEP to predict PPNDs was analyzed by multiple regression analyses and assessed by the area under the receiver operating characteristic curve. In a population of 888 patients, SSEP changes occurred in 8.6% (n = 77). Twenty-eight patients (3.1%) suffered PPNDs. A 50% to 99% loss in SSEP waveform was associated with a 20-fold increase in risk of PPND; a total loss of SSEP waveform, regardless of permanence, was associated with a greater than 200-fold risk of PPND. SSEPs displayed very good predictive ability for PPND, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.92). This study supports the predictive ability of SSEPs for the detection of PPNDs. The magnitude and persistence of SSEP changes is clearly associated with the development of PPNDs. The utility of SSEP monitoring in detecting ischemia may provide an opportunity for neurointerventionalists to respond to changes intraoperatively to mitigate the potential for PPNDs.

  12. Is Internal Iliac Artery Embolization Essential Prior to Endovascular Repair of Aortoiliac Aneurysms?

    SciTech Connect

    Bharwani, N. Raja, J.; Choke, E.; Belli, A. M.; Thompson, M. M.; Morgan, R. A.; Munneke, G.

    2008-05-15

    Patients who undergo endovascular repair of aorto-iliac aneurysms (EVAR) require internal iliac artery (IIA) embolization (IIAE) to prevent type II endoleaks after extending the endografts into the external iliac artery. However, IIAE may not be possible in some patients due to technical factors or adverse anatomy. The aim of this study was to assess retrospectively whether patients with aorto-iliac aneurysms who fail IIAE have an increase in type II endoleak after EVAR compared with similar patients who undergo successful embolization. We retrospectively analyzed the records of 148 patients who underwent EVAR from December 1997 to June 2005. Sixty-one patients had aorto-iliac aneurysms which required IIAE before EVAR. Fifty patients had successful IIAE and 11 patients had unsuccessful IIAE prior to EVAR. The clinical and imaging follow-up was reviewed before and after EVAR. The endoleak rate of the embolized group was compared with that of the group in whom embolization failed. After a mean follow-up of 19.7 months in the study group and 25 months in the control group, there were no statistically significant differences in outcome measures between the two groups. Specifically, there were no type II endoleaks related to the IIA in patients where IIAE had failed. We conclude that failure to embolize the IIA prior to EVAR should not necessarily preclude patients from treatment. In patients where there is difficulty in achieving coil embolization, it is recommended that EVAR should proceed, as clinical sequelae are unlikely.

  13. Single-center experience in the endovascular treatment of wide-necked intracranial aneurysms with a bridging intra-/extra-aneurysm implant (pCONus)

    PubMed Central

    Fischer, S; Weber, A; Titschert, A; Brenke, C; Kowoll, A; Weber, W

    2016-01-01

    Purpose To retrospectively evaluate the safety and efficacy of the endovascular treatment of wide-necked intracranial aneurysms assisted by a novel intra-/extra-aneurysm stent-like implant (pCONus). Methods Initial and follow-up angiographic and clinical results are presented of 25 patients with 25 unruptured and ruptured wide-necked intracranial aneurysms treated by reconstruction of the aneurysm neck using the pCONus implant followed by coil occlusion of the fundus. Results Successful intra-/extra-aneurysm deployment of the pCONus with coil occlusion of the fundus was achieved in all but one case. Procedure-related ischemic complications were observed in three cases with permanent deterioration in one. Acceptable aneurysm occlusion was achieved in all cases. Follow-up angiography revealed sufficient occlusion in 81.0% of the aneurysms. Intimal hyperplasia in the stented segment of the parent artery or device migration has not been observed to date. Conclusions The pCONus device offers a promising treatment option for complex wide-necked bifurcation intracranial aneurysms. Acute or delayed dislocations of coils into the parent artery are successfully avoided. PMID:26658279

  14. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    SciTech Connect

    Ketelsen, Dominik; Kalender, Guenay; Heuschmid, Martin; Syha, Roland; Mangold, Stefanie; Claussen, Claus D.; Brechtel, Klaus

    2011-10-15

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  15. Endovascular repair of descending thoracic aortic aneurysm: an evidence-based analysis.

    PubMed

    2005-01-01

    To conduct an assessment on endovascular repair of descending thoracic aortic aneurysm (TAA). Aneurysm is the most common condition of the thoracic aorta requiring surgery. Aortic aneurysm is defined as a localized dilatation of the aorta. Most aneurysms of the thoracic aorta are asymptomatic and incidentally discovered. However, TAA tends to enlarge progressively and compress surrounding structures causing symptoms such as chest or back pain, dysphagia (difficulty swallowing), dyspnea (shortness of breath), cough, stridor (a harsh, high-pitched breath sound), and hoarseness. Significant aortic regurgitation causes symptoms of congestive heart failure. Embolization of the thrombus to the distal arterial circulation may occur and cause related symptoms. The aneurysm may eventually rupture and create a life-threatening condition. The overall incidence rate of TAA is about 10 per 100,000 person-years. The descending aorta is involved in about 30% to 40% of these cases. The prognosis of large untreated TAAs is poor, with a 3-year survival rate as low as 25%. Intervention is strongly recommended for any symptomatic TAA or any TAA that exceeds twice the diameter of a normal aorta or is 6 cm or larger. Open surgical treatment of TAA involves left thoracotomy and aortic graft replacement. Surgical treatment has been found to improve survival when compared with medical therapy. However, despite dramatic advances in surgical techniques for performing such complex operations, operative mortality from centres of excellence are between 8% and 20% for elective cases, and up to 50% in patients requiring emergency operations. In addition, survivors of open surgical repair of TAAs may suffer from severe complications. Postoperative or postprocedural complications of descending TAA repair include paraplegia, myocardial infarction, stroke, respiratory failure, renal failure, and intestinal ischemia. Endovascular aortic aneurysm repair (EVAR) using a stent graft, a procedure called

  16. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    SciTech Connect

    Waduud, Mohammed Abdul; Choong, Wen Ling; Ritchie, Moira Williams, Claire; Yadavali, Reddi; Lim, Shueh; Buchanan, Fraser; Bhat, Raj; Ramanathan, Krishnappan; Ingram, Susan Cormack, Laura; Moss, Jonathan G.

    2015-02-15

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

  17. Type II Endoleak after Endovascular Aneurysm Repair: Natural History and Treatment Outcomes.

    PubMed

    Kumar, Liana; Cowled, Prue; Boult, Margaret; Howell, Stuart; Fitridge, Robert

    2017-10-01

    The natural history of type II endoleaks and linkage to aneurysm rupture is unclear. Likewise, treatment recommendations are controversial. The aim of this study was to examine the incidence, factors associated with type II endoleaks, and outcomes in an Australia cohort of patients who have undergone endovascular aneurysm repair (EVAR). Data from 693 patients who underwent EVAR between 2009 and 2013 at multiple institutions across Australia were studied. Patients who developed (1) type II endoleak and (2) type II endoleak with sac expansion were compared for preoperative demographics, mortality, sac expansion, aneurysm rupture, and intervention rates. A total of 225 patients developed type II endoleak over a mean follow-up of 1.9 years (±1.0 years), out of which 133 spontaneously resolved, 37 were untreated unresolved, and 16 underwent intervention. Type I and III endoleaks occurred in 50 and 19 patients, respectively. Smoking (P = 0.002) and warfarin (P = 0.044) were protective factors for development of type II endoleak, whereas age (P = 0.034), right iliac artery tortuosity (P = 0.031), and right (P = 0.008) and left external iliac diameters (P = 0.028) were risk factors for endoleak. Three patients suffered aneurysm ruptures in the entire cohort. All ruptures occurred in type II endoleak patients, of which two occurred after reintervention and in the absence of sac expansion (>5 mm). Late type II endoleak occurred in 117 patients, out of which 26 had sac expansion. Of those without late type II endoleak, 25 have sac expansion. There was no statistically significant difference in survival between those with and without type II endoleak. Age (P < 0.0001) and smoking (P = 0.001) were significant independent predictive factors for survival in this patient sample. Treatment outcomes were encouraging with most cases involving endoleak resolution (15 of 16 patients) and no sac expansion after intervention (0 of 8 patients with complete follow

  18. Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

    PubMed Central

    Gedikoglu, Murat; Oguzkurt, Levent

    2017-01-01

    PURPOSE We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. METHODS This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. RESULTS Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. CONCLUSION Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis. PMID:27801353

  19. Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair.

    PubMed

    Verhoeven, Bart A N; Waasdorp, Evert J; Gorrepati, Madhu L; van Herwaarden, Joost A; Vos, Jan Albert; Wille, Jan; Moll, Frans L; Zarins, Christopher K; de Vries, Jean Paul P M

    2011-02-01

    Since the introduction of endovascular aneurysm repair (EVAR), long-term follow-up studies reporting single-device results are scarce. In this study, we focus on EVAR repair with the Talent stent graft (Medtronic, Santa Rosa, Calif). Between July 2000 and December 2007, 365 patients underwent elective EVAR with a Talent device. Patient data were gathered prospectively and evaluated retrospectively. By American Society of Anesthesiologists category, 74% were categories III and IV. Postoperative computed tomography (CT) scanning was performed before discharge, at 3, 12 months, and yearly thereafter. Data are presented according to reporting standards for EVAR. The mean proximal aortic neck diameter was 27 mm (range, 16-36 mm), with a neck length <15 mm in 31% (data available for 193 patients). Deployment of endografts was successful in 361 of 365 patients (99%). Initially, conversion to laparotomy was necessary in four patients. Primary technical success determined by results from computed tomography (CT) scans before discharge was achieved in 333 patients (91%). Proximal type I endoleaks were present in 28 patients (8%) during follow-up, and 14 of these patients needed additional treatment for type I endoleak. The 30-day mortality for the whole Talent group was 1.1% (4 of 365). Follow-up to 84 months is reported for 24 patients. During follow-up, 122 (33%) patients died; in nine, death was abdominal aortic aneurysm (AAA)-related (including 30-day mortality). Kaplan-Meier estimates revealed primary clinical success rates of 98% at 1 year, 93% at 2 years, 88% at 3 years, 79% at 4 years, 64% at 5 years, 51% at 6 years, and 48% at 7 years. Secondary interventions were performed in 73 of 365 patients (20%). Ten conversions for failed endografts were performed. Life-table yearly risk for AAA-related reintervention was 6%, yearly risk for conversion to open repair was 1.1%, yearly risk for total mortality was 8.9%, and yearly risk for AAA-related mortality was 0

  20. Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results.

    PubMed

    Bozzetto Ambrosi, Patricia; Gory, Benjamin; Sivan-Hoffmann, Rotem; Riva, Roberto; Signorelli, Francesco; Labeyrie, Paul-Emile; Eldesouky, Islam; Sadeh-Gonike, Udi; Armoiry, Xavier; Turjman, Francis

    2015-08-01

    The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4-10.7 mm), and average neck size was 4.9 mm (range 2.6-6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment. © The Author(s) 2015.

  1. Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

    PubMed Central

    Bozzetto Ambrosi, Patricia; Sivan-Hoffmann, Rotem; Riva, Roberto; Signorelli, Francesco; Labeyrie, Paul-Emile; Eldesouky, Islam; Sadeh-Gonike, Udi; Armoiry, Xavier; Turjman, Francis

    2015-01-01

    Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment. PMID:26111987

  2. Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm: A prospective observational study.

    PubMed

    Zhang, Linjing; Wang, Yunxia; Zhang, Qingkui; Ge, Wei; Wu, Xiancong; Di, Hai; Wang, Jun; Cao, Xiangyu; Li, Baomin; Liu, Ruozhuo; Yu, Shengyuan

    2017-02-01

    The aim of this study was to investigate whether there is a long-term improvement in headache of patients with unruptured intracranial aneurysms (UIAs) treated with intracranial endovascular procedures.Using a prospective design, consecutive patients with UIAs with neuroendovascular treatment from January 2014 to December 2014 were asked to participate. Headache outcomes were established before aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated.Ultimately, 58 patients completed the 6-month follow-up. In total, 29 patients had preoperative headache. Six months after the intracranial endovascular procedure, 13 patients (44.8%) stated that their headaches were relieved after endovascular treatment; headache in 1 patient improved slightly, and 12 reported disappearance of headache and marked improvement. Overall, the mean headache scores of 29 patients improved on the self-reported Numeric Rating Scale (NRS) after endovascular treatment (6.00 vs. 2.30; P < 0.001). Patients with pretreatment tension-type headache, more severe headaches, stent-assisted coiling, and stent implantation of the aneurysm were the important disadvantage for patients in improvement of post-procedure headache.Treatment of UIAs resulted in relief of headaches in about half of patients who had headaches pre-operatively.

  3. Long-term results after accessory renal artery coverage during endovascular aortic aneurysm repair.

    PubMed

    Greenberg, Joshua I; Dorsey, Chelsea; Dalman, Ronald L; Lee, Jason T; Harris, E J; Hernandez-Boussard, Tina; Mell, Matthew W

    2012-08-01

    Current information regarding coverage of accessory renal arteries (ARAs) during endovascular aneurysm repair (EVAR) is based on small case series with limited follow-up. This study evaluates the outcomes of ARA coverage in a large contemporary cohort. Consecutive EVAR data from January 2004 to August 2010 were collected in a prospective database at a University Hospital. Patient and aneurysm-related characteristics, imaging studies, and ARA coverage versus preservation were analyzed. Volumetric analysis of three-dimensional reconstruction computed tomography scans was used to assess renal infarction volume extent. Long-term renal function and overall technical success of aneurysm exclusion were compared. A cohort of 426 EVARs was identified. ARAs were present in 69 patients with a mean follow-up of 27 months (range, 1 to 60 months). Forty-five ARAs were covered in 40 patients; 29 patients had intentional ARA preservation. Patient and anatomic characteristics were similar between groups except that ARA coverage patients had shorter aneurysm necks (P = .03). Renal infarctions occurred in 84% of kidneys with covered ARAs. There was no significant deterioration in long-term glomerular filtration rate when compared with patients in the control group. No difference in the rate of endoleak, secondary procedures, or the requirement for antihypertensive medications was found. This study is the largest to date with the longest follow-up relating to ARA coverage. Contrary to previous reports, renal infarction after ARA coverage is common. Nevertheless, coverage is well tolerated based upon preservation of renal function without additional morbidity. These results support the long-term safety of ARA coverage for EVAR when necessary. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  4. Ten-Year Single-Center Results of Abdominal Aortic Aneurysm Treatment: Endovascular versus Open Repair.

    PubMed

    Majd, Payman; Ahmad, Wael; Becker, Ingrid; Brunkwall, Jan Sigge

    2017-10-01

    The purpose of the present study was to compare the long-term survival in matched cohorts of patients with infrarenal abdominal aortic aneurysm (AAA) undergoing an elective open repair (OR) or an endovascular aneurysm repair (EVAR). Patients with a primary elective repair of an infrarenal aortic aneurysm between 1998 and 2006 were identified in a retrospective review of our single-center database. EVAR and OR patients were matched with respect to age, gender, renal disease, tobacco use, hypertension, chronic obstructive pulmonary disease, and coronary artery disease. The primary end points were the early mortality and all-cause mortality during follow-up. A total of 465 patients with elective infrarenal aortic aneurysm repair were identified in the database. The EVAR and OR patients were matched according to the above-mentioned characteristics, and finally, 108 patients were included in each group. The early mortality encountered was only one death in the open group (P = 0.316). The Kaplan-Meier survival analysis by the log-rank test showed no difference in cumulative survival between OR group and EVAR group (P = 0.458). Seventeen reinterventions (16.7%) in the EVAR group vs. 7 (6.5%) in the OR group (P = 0.018) were necessary during follow-up. OR and EVAR can be performed safely for elective treatment of AAA. The reintervention rate is, as expected, significantly higher in the EVAR group, but the long-term survival remains equal in both groups. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair

    PubMed Central

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-01-01

    Abstract The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. “Shaggy aorta” presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), “shaggy aorta” (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors. PMID:27082585

  6. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair.

    PubMed

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-04-01

    The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. "Shaggy aorta" presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), "shaggy aorta" (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors.

  7. Application of endovascular coiling and subsequent Onyx 34 embolization in anterior communicating artery aneurysms with adjacent hematoma.

    PubMed

    Fang, Yi-Bin; Li, Qiang; Yang, Peng-Fei; Zhang, Qi; Wu, Yi-Na; Feng, Zheng-Zhe; Huang, Qing-Hai; Xu, Yi; Liu, Jian-Min

    2014-08-01

    Small anterior communicating artery aneurysms with recurrent bleeding and adjacent hematoma may have a high risk of post-operative rebleeding. This clinical study summarizes our preliminary experience with this subset of aneurysms, which were treated with endovascular coiling and subsequent Onyx 34 embolization. We retrospectively reviewed the data of 9 patients suffering from small anterior communicating artery aneurysms treated with the combination of coils and Onyx. The clinical characteristics, angiographic outcomes, and follow-up results are reviewed. Endovascular coiling and Onyx embolization were successfully accomplished in all 9 cases. The Raymond scale ratings of the treatments are all class I with the parent arteries kept patent. One patient died of severe brain edema on the 5th post-operative day. The modified Rankin scale (mRS) score for the other 8 patients at follow-ups (6m to 26m, 15.8m on average) was 0 in 5 cases, 1 in 2 cases, and 3 in 1 case. Seven of 8 patients (87.5%) underwent angiographic follow-up that demonstrated persistent durable occlusion with no recanalization. Endovascular coiling and subsequent Onyx 34 embolization may be effective in treating anterior communicating artery aneurysms with adjacent hematoma. Further studies with larger sample size and adequate follow-up are required to verify its safety and efficacy as well as to evaluate the long-term outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Prediction of deformations during endovascular aortic aneurysm repair using finite element simulation.

    PubMed

    Kaladji, Adrien; Dumenil, Aurélien; Castro, Miguel; Cardon, Alain; Becquemin, Jean-Pierre; Bou-Saïd, Benyebka; Lucas, Antoine; Haigron, Pascal

    2013-03-01

    During endovascular aortic aneurysm repair (EVAR), the introduction of medical devices deforms the arteries. The aim of the present study was to assess the feasibility of finite element simulation to predict arterial deformations during EVAR. The aortoiliac structure was extracted from the preoperative CT angiography of fourteen patients underwent EVAR. The simulation consists in modeling the deformation induced by the stiff wire used during EVAR. The results of the simulation were projected onto the intraoperative images, using a 3D/2D registration. The mean distance between the real and simulated guidewire was 2.3±1.1mm. Our results demonstrate that finite element simulation is feasible and appear to be reproducible in modeling device/tissue interactions and quantifying anatomic deformations during EVAR.

  9. Endovascular aneurysm repair in emergent ruptured abdominal aortic aneurysm with a ‘real’ hostile neck and severely tortuous iliac artery of an elderly patient

    PubMed Central

    2014-01-01

    Background Endovascular aneurysm repair (EVAR) has been a revolutionary development in the treatment of abdominal aortic aneurysms (AAAs). Meanwhile, unfavorable anatomy of the aneurysm has always been a challenge to vascular surgeons, and the application of EVAR in emergent and elderly patients are still in dispute. Case presentation A 79-year-old woman presented as an emergency of abdominal pain with acute hypotension, heart rate elevation and a rapid decrease of hemoglobin. Emergent computed tomographic angiography (CTA) showed a ruptured AAA (rAAA) extending from below the opening of bilateral renal arteries down to the celiac artery and elongated to both common iliac arteries. The hostile neck and severely tortuous iliac artery made the following procedure a great challenge. An emergent endovascular approach was performed in which an excluder aortic main body was deployed below the origin of the bilateral renal arteries covering the ruptured aortic segment. Two iliac legs were placed superior to the opening of the right hypogastric respectively. In order to avoid the type Ib endoleak, we tried to deploy another cuff above the bifurcation of the iliac artery. However, the severely tortuous right iliac artery made this procedure extremely difficult, and a balloon-assisted technique was used in order to keep the stiff wire stable. Another iliac leg was placed above the bifurcation of the left iliac artery. The following angiography showed a severe Ia endoleak in the proximal neck and therefore, a cuff was deployed distal to opening of the left renal artery with off-the-shelf solution. The patient had an uneventful recovery with a resolution of the rAAA. She is well and symptom-free 6 months later. Conclusion Endovascular aneurysm repair (EVAR) in emergent elderly rAAA with hostile neck and severe tortuous iliac artery is extremely challenging, and endovascular management with integrated technique is feasible and may achieve a satisfactory early result. PMID

  10. Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein--series of 18 cases.

    PubMed

    Guibaud, L; Herbreteau, D; Dubois, J; Stempfle, N; Bérard, J; Pracros, J P; Merland, J J

    1998-08-01

    To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.

  11. Large Diameter Limbs for Dilated Common Iliac Arteries in Endovascular Aneurysm Repair. Is It Safe?

    SciTech Connect

    Malagari, Katerina Brountzos, Elias; Gougoulakis, Alexandros; Papathanasiou, Matilda; Alexopoulou, Efthymia; Mastorakou, Renata; Kelekis, Dimitris

    2004-09-15

    In this prospective study we examined whether dilated common iliac arteries (CIAs) can provide a safe distal seal in endovascular aneurysm repair (EVAR) with the use of bifurcated stent grafts with large diameter limbs. Sixteen patients with 26 dilated CIAs with a diameter of {>=}6 mm who were offered EVAR using stent grafts with large diameter limbs were included in the study (Group A). Forty-two patients who also underwent EVAR without iliac dilatation, matched for age, sex and surgical risk were used for comparison (controls-Group B). In group A mean CIA diameter was 18.2 mm (16-28) and mean abdominal aortic aneurysm (AAA) diameter was 6.87 {+-} 1.05 cm; mean age was 77.2 {+-} 4.8 yrs (67-81). Mean follow-up was 33.6 months (2.8 yrs). CIA diameter changes and development of endoleaks were assessed by CT angiography (CTA). Overall iliac dilatation was present in 16/58 of our patients (27.6%). In 10 patients dilatation was bilateral (17.3%). Partial or complete flow to the internal iliac artery (IIA) territories was preserved in all patients post-EVAR. On follow-up, stable caliber of the dilated CIAs was observed in 21 patients (84%), enlargement of 1mm in 3 (16%), and failure of the distal attachment in 1 (6.2%). Compared to the control group there was no statistical significance in the incidence of complications. Dilated common iliac arteries provide a safe distal seal in patients who have undergone EVAR, thus obviating the need for additional endovascular procedures and sparing flow in the IIA vascular bed.

  12. Early Experiences with the Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm

    PubMed Central

    Choi, Jae-Sung; Oh, Se Jin; Sung, Yong Won; Moon, Hyun Jong; Lee, Jung Sang

    2016-01-01

    Background The aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition. Methods Among 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA. Results The mean age was 72.4±5.1 years, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was 269.8±72.3 minutes. The mean total length of aortic coverage was 186.0±49.2 mm. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of 16.8±14.8 months, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown. Conclusion TEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs. PMID:27064672

  13. Endovascular Treatment of Late Thoracic Aortic Aneurysms after Surgical Repair of Congenital Aortic Coarctation in Childhood

    PubMed Central

    Juszkat, Robert; Perek, Bartlomiej; Zabicki, Bartosz; Trojnarska, Olga; Jemielity, Marek; Staniszewski, Ryszard; Smoczyk, Wiesław; Pukacki, Fryderyk

    2013-01-01

    Background In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs. Methods This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. Results Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. Conclusions The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary. PMID:24386233

  14. CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair.

    PubMed

    Sailer, A M; de Haan, M W; Peppelenbosch, A G; Jacobs, M J; Wildberger, J E; Schurink, G W H

    2014-04-01

    To evaluate the effect of intraoperative guidance by means of live fluoroscopy image fusion with computed tomography angiography (CTA) on iodinated contrast material volume, procedure time, and fluoroscopy time in endovascular thoraco-abdominal aortic repair. CTA with fluoroscopy image fusion road-mapping was prospectively evaluated in patients with complex aortic aneurysms who underwent fenestrated and/or branched endovascular repair (FEVAR/BEVAR). Total iodinated contrast material volume, overall procedure time, and fluoroscopy time were compared between the fusion group (n = 31) and case controls (n = 31). Reasons for potential fusion image inaccuracy were analyzed. Fusion imaging was feasible in all patients. Fusion image road-mapping was used for navigation and positioning of the devices and catheter guidance during access to target vessels. Iodinated contrast material volume and procedure time were significantly lower in the fusion group than in case controls (159 mL [95% CI 132-186 mL] vs. 199 mL [95% CI 170-229 mL], p = .037 and 5.2 hours [95% CI 4.5-5.9 hours] vs. 6.3 hours (95% CI 5.4-7.2 hours), p = .022). No significant differences in fluoroscopy time were observed (p = .38). Respiration-related vessel displacement, vessel elongation, and displacement by stiff devices as well as patient movement were identified as reasons for fusion image inaccuracy. Image fusion guidance provides added value in complex endovascular interventions. The technology significantly reduces iodinated contrast material dose and procedure time. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

    PubMed Central

    Chen, Xiyang; Zhao, Jichun; Huang, Bin; Yuan, Ding; Yang, Yi; Ma, Yukui

    2016-01-01

    Abstract Introduction: Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA. Clinical Finding: An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient. Diagnosis: Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed. Interventions: Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient. Outcomes: Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed. Conclusion: ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management. PMID:27893667

  16. Endovascular treatment of a ruptured pulmonary artery aneurysm in a patient with Behçet's disease using the Amplatzer Vascular Plug 4.

    PubMed

    Ianniello, Andrea; Carrafiello, Gianpaolo; Nicotera, Paolo; Vaghi, Adriano; Cazzulani, Alberto

    2013-01-01

    A pulmonary artery aneurysm is a common manifestation and the leading cause of mortality in Behçet's disease. We describe a case of spontaneous rupture of a pulmonary artery aneurysm that, due to the inadequacy of medical therapy and the disadvantages of surgery, became the ideal candidate for endovascular management and was successfully performed by using the Amplatzer Vascular Plug 4.

  17. Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm.

    PubMed

    Damiano, Robert J; Ma, Ding; Xiang, Jianping; Siddiqui, Adnan H; Snyder, Kenneth V; Meng, Hui

    2015-09-18

    Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1-8 coils), single FD, FD with adjunctive coils (1-8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low packing density (PD) coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome.

  18. Endovascular Therapy of Bronchial Artery Aneurysm: Five Cases With Six Aneurysms

    SciTech Connect

    Lue, Peng-Hua Wang Lifu; Su Yusheng; Lee, Deok-Hee; Wang Shuxiang; Sun Ling; Geng Suping; Huang Wennuo

    2011-06-15

    The objective of this study was to investigate the effect of transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in patients with bronchial artery aneurysm (BAA). From January 2005 to January 2010, five patients presenting hemoptysis with six BAAs were treated with NBCA-Lipiodol mixture, including intra-aneurysm embolization (IAE) in one patient. Adjuvant embolization with spherical polyvinyl alcohol (PVA) embolic microparticles or NBCA was first performed to embolize the distal engorged bronchiectatic arteries. Bronchial arterial angiography showed six BAAs (four in the right lobe and two in the left lobe) and some engorged, tortuous bronchial arteries. TAE through microcatheter was successful in all cases. Postembolization angiogram demonstrated the NBCA cast and total occlusion of BAAs and bronchiectatic engorged vessels. After these procedures, hemoptysis completely disappeared in all patients. Follow-up computed tomography (CT) scan was performed at an average of 3 months (range 2 to 6), which showed no enhancement of BAAs and accumulation of NBCA. TAE is a minimally invasive, effective, and reliable approach for treatment for patients with BAA. NBCA-Lipiodol mixture provides a good choice for treatment of BAA, especially when catheterization of the efferent branches is impossible.

  19. Migration of the Zenith Flex Device during Endovascular Aortic Repair of an Infrarenal Aortic Aneurysm with a Severely Angulated Neck

    PubMed Central

    Nishimaki, Hiroshi; Chiba, Kiyoshi; Murakami, Kenji; Sakurai, Yuka; Fujiwara, Keishi; Miyairi, Takeshi; Nakajima, Yasuo

    2016-01-01

    A woman in her 80s with an infrarenal aortic aneurysm was scheduled for endovascular aortic repair (EVAR). The aneurysm had a severely angulated neck (SAN), and the Zenith Flex device was selected. Completion angiography showed migration of the main body resulting in right renal artery stenosis. A Palmaz genesis was placed across the renal orifice. The patient had no renal dysfunction and was discharged 7 days after EVAR. If Zenith Flex devices are used for a SAN, it is necessary to consider not only the position of the renal artery but also the appropriate position of the stent-graft. PMID:27738470

  20. Ion-implantation and characterization of 32P-radioactive platinum coils for endovascular treatment of intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Leblanc, Philippe; Raymond, Jean; Roorda, Sjoerd

    2006-01-01

    We produced and measured over 800 32P-ion-implanted coils for pre-clinical and clinical studies. Platinum coils are intravascular implants most frequently used in the treatment of intracranial aneurysms. This less invasive endovascular approach is safer than conventional surgery, but a frequent drawback is the recurrence of the aneurysm, associated with recanalization, a phenomenon that can be inhibited by the local application of beta radiation. Total coil activities, uniformity, reproducibility and 32P binding to platinum were determined and found to be adequate for this application.

  1. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  2. Endovascular Therapy of Ruptured Abdominal Aortic Aneurysm: Mid- and Long-Term Results

    SciTech Connect

    Kubin, Klaus Sodeck, Gottfried H.; Teufelsbauer, H.; Nowatschka, Bernd; Kretschmer, Georg; Lammer, Johannes; Schoder, Maria

    2008-05-15

    As an alternative to open aneurysm repair, emergency endovascular aortic repair (EVAR) has emerged as a promising technique for ruptured abdominal aortic aneurysm (rAAA) within the last decade. The aim of this retrospective study is to present early and late outcomes of patients treated with EVAR for rAAA. Twenty-two patients (5 women, 17 men; mean age, 74 years) underwent EVAR for rAAA between November 2000 and April 2006. Diagnostic multislice computed tomography angiography was performed prior to stent-graft repair to evaluate anatomical characteristics and for follow-up examinations. Periprocedural patient characteristics and technical settings were evaluated. Mortality rates, hospital stay, and early and late complications, within a mean follow-up time of 744 {+-} 480 days, were also assessed. Eight of 22 patients were hemodynamically unstable at admission. Stent-graft insertion was successful in all patients. The total early complication rate was 54%, resulting in a 30-day mortality rate of 23%. The median intensive care unit stay was 2 days (range, 2-48 days), and the median hospital stay was 16 days (range, 9-210 days). During the follow-up period, three patients suffered from stent-graft-related complications. The overall mortality rate in our study group was 36%. EVAR is an acceptable, minimally invasive treatment option in patients with acute rAAA, independent of the patient's general condition. Short- and long-term outcomes are definitely comparable to those with open surgical repair procedures.

  3. Circulating biomarkers are not associated with endoleaks after endovascular repair of abdominal aortic aneurysms.

    PubMed

    Moxon, Joseph V; Ng, Eugene; Lazzaroni, Sharon M; Boult, Margaret; Velu, Ramesh; Fitridge, Robert A; Golledge, Jonathan

    2017-08-23

    Endoleak is a common complication of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) but can be detected only through prolonged follow-up with repeated aortic imaging. This study examined the potential for circulating matrix metalloproteinase 9 (MMP9), osteoprotegerin (OPG), D-dimer, homocysteine (HCY), and C-reactive protein (CRP) to act as diagnostic markers for endoleak in AAA patients undergoing elective EVAR. Linear mixed-effects models were constructed to assess differences in AAA diameter after EVAR between groups of patients who did and did not develop endoleak during follow-up, adjusting for potential confounders. Circulating MMP9, OPG, D-dimer, HCY, and CRP concentrations were measured in preoperative and postoperative plasma samples. The association of these markers with endoleak diagnosis was assessed using linear mixed effects adjusted as before. The potential for each marker to diagnose endoleak was assessed using receiver operating characteristic curves. Seventy-five patients were included in the study, 24 of whom developed an endoleak during follow-up. Patients with an endoleak had significantly larger AAA sac diameters than those who did not have an endoleak. None of the assessed markers showed a significant association with endoleak. This was confirmed through receiver operating characteristic curve analyses indicating poor diagnostic ability for all markers. Circulating concentrations of MMP9, OPG, D-dimer, HCY, and CRP were not associated with endoleak in patients undergoing EVAR in this study. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  4. Ruptured abdominal aortic aneurysm: endovascular repair is feasible in 40% of patients.

    PubMed

    Reichart, M; Geelkerken, R H; Huisman, A B; van Det, R J; de Smit, P; Volker, E Ph

    2003-11-01

    Open repair of ruptured abdominal aortic aneurysm (rAAA) still has a high mortality. Endovascular aortic repair (EVAR) may be the way to improve survival rates. However, it is not clear how many patients with rAAA will be suitable for acute EVAR. Between October 2000 and April 2002 all patients with acute symptomatic or ruptured AAA were assessed for EVAR on an intention-to-treat basis with emergency computed tomographic angiography (CTA). Patient and logistic characteristics were analysed. We used two commercially available aorto uni-iliac devices with a maximum proximal diameter of 28 and 34 mm. Five out of 26 patients were excluded for CTA and EVAR because of severe and persistent hypotension (3 pts) or logistic reasons (2 pts, both eligible). Twelve patients were found not eligible for EVAR due to unsuitable infrarenal aortic neck length (3 pts), neck diameter (1 pt) or a combination of both (8 pts). The remaining six patients were treated with EVAR. After 6 months no graft failure or aneurysm related deaths were recorded in the EVAR group. A total of 28% of patients with symptomatic or ruptured AAA was treated with EVAR. A potential 42% of patients could have been suitable for EVAR, if the correct devices had been in stock and all patients had been properly assessed.

  5. Bladder and rectal incontinence without paraplegia or paraparesis after endovascular aneurysm repair.

    PubMed

    Nishioka, Naritomo; Kurimoto, Yoshihiko; Maruyama, Ryushi; Ujihira, Kosuke; Iba, Yutaka; Hatta, Eiichiro; Yamada, Akira; Nakanishi, Katsuhiko

    2016-12-01

    Spinal cord ischemia is a well-known potential complication of endovascular aneurysm repair (EVAR), and it is usually manifested by paraplegia or paraparesis. We describe a case in which spinal cord ischemia after EVAR presented by isolated bladder and rectal incontinence without other neurological deficits. A 63-year-old woman presented with intermittent claudication secondary to an infrarenal abdominal aortic aneurysm (AAA), and a left common iliac artery obstruction, for which she underwent EVAR using an aorto-uniiliac (AUI) device and ilio-femoral artery bypass. On postoperative day 3, she developed urinary and fecal incontinence without signs of paraplegia or paraparesis. Magnetic resonance imaging (MRI) showed a hyper-intense signal in the spinal cord. She received hyperbaric oxygen (HBO) therapy and was discharged after 18 days when her urinary and fecal incontinence were almost resolved. This report suggests that spinal cord ischemia after EVAR for aortoiliac occlusive disease might present as bladder and rectal incontinence without other neurological manifestations.

  6. Impact of sarcopenia on long-term mortality following endovascular aneurysm repair.

    PubMed

    Hale, Allyson L; Twomey, Kayla; Ewing, Joseph A; Langan, Eugene M; Cull, David L; Gray, Bruce H

    2016-06-01

    Sarcopenia, also known as a reduction of skeletal muscle mass, is a patient-specific risk factor for vascular and cancer patients. However, there are no data on abdominal aortic aneurysm (AAA) patients treated with endovascular aneurysm repair (EVAR) who have sarcopenia. To determine the impact of sarcopenia on mortality following EVAR, we retrospectively reviewed 200 patients treated with EVAR by estimating muscle mass on abdominal computed tomography (CT) scans. Mortality was analyzed according to its presence (n=25) or absence (n=175). Sarcopenia was more common in women than men (32.0% vs 9.7%; p=0.005). Patients with sarcopenia had an increased risk of mortality compared to those without (76% vs 48%; p=0.016). Of note, the overall mortality rate was 51% with a median follow up of 8.4 years (interquartile range, 5.3-11.7). In conclusion, the presence of sarcopenia on a CT scan is an important predictor of long-term mortality in patients treated for AAA with EVAR. Pending further study, these data suggest that sarcopenia may aid in pre-procedural long-term survival assessment of patients undergoing EVAR. © The Author(s) 2016.

  7. The impact of endovascular repair of ruptured abdominal aortic aneurysm on the gastrointestinal and renal function.

    PubMed

    Makar, R R; Badger, S A; O'Donnell, M E; Soong, C V; Lau, L L; Young, I S; Hannon, R J; Lee, B

    2014-01-01

    Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA) may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR) compared to open repair (OR). Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT) findings. Renal function was monitored by estimated glomerular filtration rate (eGFR), serum urea and creatinine, and urinary albumin creatinine ratio (ACR). Hepatic function was assessed postoperatively for 5 days. Intestinal function was determined by the paracetamol absorption test. Intestinal permeability was assessed by urinary lactulose/mannitol ratio. Results. 30 rAAA patients were included. Fourteen had eEVAR and sixteen eOR. Serum urea were higher in eOR, while creatinine was similar between groups. Hepatic function showed no intergroup difference. Paracetamol absorption was increased in eEVAR group at day 3 compared to day 1 (P = 0.03), with no similar result in eOR (P = 0.24). Peak lactulose/mannitol ratio was higher in eOR (P = 0.03), with higher urinary L/M ratio in eOR at day 3 (P = 0.02). Clinical intestinal function returned quicker in eEVAR (P = 0.02). Conclusion. EVAR attenuated the organ dysfunction compared to open repair. However, a larger comparative trial would be required to validate this. The clinical trial is registered with reference number EUDRACT: 2013-003373-12.

  8. A comparison of Percutaneous femoral access in Endovascular Repair versus Open femoral access (PiERO): study protocol for a randomized controlled trial.

    PubMed

    Vierhout, Bastiaan P; Saleem, Ben R; Ott, Alewijn; van Dijl, Jan Maarten; de Kempenaer, Ties D van Andringa; Pierie, Maurice E N; Bottema, Jan T; Zeebregts, Clark J

    2015-09-14

    Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar(™) and Proglide(™) devices (Abbott Vascular). Positive effects of these devices seem to consist of a lower infection rate, and shorter operation time and hospital stay. This conclusion was published in previous reports comparing techniques in patients in two different groups (cohort or randomized). Access techniques were never compared in one and the same patient; this research simplifies comparison because patient characteristics will be similar in both groups. Percutaneous access of the CFA is compared to surgical cutdown in a single patient; in EVAR surgery, access is necessary in both groins in each patient. Randomization is performed on the introduction site of the larger main device of the endoprosthesis. The contralateral device of the endoprosthesis is smaller. When we use this type of randomization, both groups will contain a similar number of main and contralateral devices. Preoperative nose cultures and perineal cultures are obtained, to compare colonization with postoperative wound cultures (in case of a surgical site infection). Furthermore, patient comfort will be considered, using VAS-scores (Visual analog scale). Punch biopsies of the groin will be harvested to retrospectively compare skin of patients who suffered a surgical site infection (SSI) to patients who did not have an SSI. The PiERO trial is a multicenter randomized controlled clinical trial designed to show the consequences of using percutaneous access in EVAR surgery and focuses on the occurrence of surgical site infections. NTR4257 10 November 2013, NL44578.042.13.

  9. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.

    PubMed

    Geisbüsch, Sarah; Stefanovic, Angelina; Koruth, Jacob S; Lin, Hung-Mo; Morgello, Susan; Weisz, Donald J; Griepp, Randall B; Di Luozzo, Gabriele

    2014-01-01

    To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model. Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis). Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair. Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

  10. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair.

    PubMed

    de Ruiter, Quirina M B; Moll, Frans L; van Herwaarden, Joost A

    2015-01-01

    This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are able to manipulate endovascular surgical tools during abdominal or thoracic aortic aneurysm repair. Reports were grouped by the navigation systems and categorized into phantom, animal, and clinical studies. First, the general characteristics of each system were compared. Second, target registration error and deployment error were used to compare the accuracy of the tracking systems. Third, all systems were reviewed for fluoroscopy time (FT), radiation dose, and contrast volumes, if reported, in rigid and nonrigid studies. Fourth, vascular cannulation performance of the systems was compared, studying cannulation time, Imperial College Complex Cannulation Scoring Tool score, and the number of wall hits and catheter movements within rigid studies. Of 721 articles and references found, 18 studies of four different navigation systems were included: the Aurora (Northern Digital, Waterloo, Ontario, Canada) tracking system, the StealthStation (Medtronic Inc, Minneapolis, Minn) tracking system, an ultrasound localization tracking system, and the Sensei (Hansen Medical, Mountain View, Calif) steerable remote-controlled robotic navigation system. The mean tracking accuracy averaged 1 mm for the three manual tracking systems measured in a rigid environment. An increase of target registration error reaching >3 mm was reported when measured in a nonrigid experimental environment or due to external distortion factors. Except within small-animal studies or case studies, no evidence was found on reduction of clinical outcome parameters, such as FT, radiation dose, and contrast volumes, within clinical EVAR. A comparison of vascular cannulation performance in rigid studies revealed that the Sensei robotic

  11. Initial experience of branched endovascular graft for abdominal aortic aneurysm with complex anatomy of proximal neck: planning and technical considerations.

    PubMed

    Higashiura, Wataru; Nagata, Takeshi; Tabayashi, Nobuoki; Itoh, Hirofumi; Sakaguchi, Shoji; Taniguchi, Shigeki; Kichikawa, Kimihiko; Uchida, Hideo

    2010-01-01

    The purpose of this report was to demonstrate initial Japanese cases of abdominal aortic aneurysm (AAA) with complex anatomy of proximal neck treated using a Zenith fenestrated endograft with branched endovascular technique and to describe the device's design and technical considerations. Planning and sizing of endografts were performed using high-resolution computed tomography on a three-dimensional workstation. Branched endograft technique combined with reinforced fenestrated device and balloon-expandable stent graft was used in two patients because of challenging morphology for the fenestrated device with a bare stent. Successful exclusion of the aneurysm sac was achieved in both patients with antegrade perfusion in incorporated visceral vessels. Endovascular repair using a fenestrated device with graft material incorporating the visceral arteries is feasible. The combination of the reinforced fenestration and the balloon-expandable stent graft can provide an adequate sealing effect for the compromised anatomy. Initial and midterm results are reported with further follow-up and patient accrual.

  12. A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair.

    PubMed

    Vourliotakis, George; Katsargyris, Αthanasios; Tielliu, Ignace F J; Zeebregts, Clark J; Verhoeven, Eric L G

    2015-02-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, the presence of the stiff guide wire does not always allow for an ideal apposition of the stent graft to the angulated common iliac artery vessel wall. We describe herein a modified technique for Gore Excluder limb-graft deployment with partial removal of the stiff wire in cases with difficult tortuous or narrow iliac arteries during endovascular abdominal aortic aneurysm repair. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Long-term results of intra-arterial onyx injection for type II endoleaks following endovascular aneurysm repair.

    PubMed

    Ribé, L; Bicknell, C D; Gibbs, R G; Burfitt, N; Jenkins, M P; Cheshire, N; Hamady, M

    2016-01-01

    Purpose The aim of this paper is to report our experience of type II endoleak treatment after endovascular aneurysm repair with intra-arterial injection of the embolizing liquid material, Onyx liquid embolic system. Methods From 2005 to 2012, we performed a retrospective review of 600 patients, who underwent endovascular repair of an abdominal aortic aneurysm. During this period, 18 patients were treated with Onyx for type II endoleaks. Principal findings The source of the endoleak was the internal iliac artery in seven cases, inferior mesenteric artery in seven cases and lumbar arteries in four cases. Immediate technical success was achieved in all patients and no endoleak from the treated vessel recurred. During a mean follow-up of 19 months, no major morbidity or mortality occurred, and one-year survival was 100%. Conclusions Treatment of type II endoleaks with Onyx is safe and effective over a significant time period.

  14. Endovascular biopsy: Technical feasibility of novel endothelial cell harvesting devices assessed in a rabbit aneurysm model.

    PubMed

    Cooke, Daniel L; Bauer, Diana; Sun, Zhengda; Stillson, Carol; Nelson, Jeffrey; Barry, David; Hetts, Steven W; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V; Su, Hua; Saeed, Maythem M

    2015-02-01

    The lack of safe and reliable methods to sample vascular tissue in situ limits discovery of the underlying genetic and pathophysiological mechanisms of many vascular disorders, including aneurysms. We investigated the feasibility and comparable efficacy of in vivo vascular endothelial cell sampling using a spectrum of endovascular devices. Using the rabbit elastase carotid aneurysm model we evaluated the performance of existing aneurysmal coils, intracranial stents, and stent-like devices to collect vascular endothelial cells. Additionally, we modified a subset of devices to assess the effects of alterations to coil pitch, coil wire contour, and stent surface finishing. Device performance was evaluated by (1) the number of viable endothelial cells harvested, (2) the degree of vascular wall damage analyzed using digital subtraction angiography and histopathological analysis, and (3) the ease of device navigability and retrieval. Isolated cells underwent immunohistochemical analysis to confirm cell type and viability. Coil and stent specifications, technique, and endothelial cell counts were tabulated and statistical analysis performed. Using conventional detachable-type and modified aneurysm coils 11 of 14 (78.6%) harvested endothelial cells with a mean of 7.93 (±8.33) cells/coil, while 15 of 15 (100%) conventional stents, stent-like devices and modified stents harvested endothelial cells with a mean of 831.33 (±887.73) cells/device. Coil stiffness was significantly associated with endothelial cell count in univariate analysis (p = 0.044). For stents and stent-like devices univariate analysis demonstrated stent-to-aorta diameter ratios (p = 0.001), stent length (p = 0.049), and the use of a pulling retrieval technique (p = 0.019) significantly predictive of endothelial cell counts, though a multivariate model using these variables demonstrated only the stent-to-aorta diameter ratio (p = 0.029) predictive of endothelial cell counts. Modified

  15. Endovascular biopsy: Technical feasibility of novel endothelial cell harvesting devices assessed in a rabbit aneurysm model

    PubMed Central

    Bauer, Diana; Sun, Zhengda; Stillson, Carol; Nelson, Jeffrey; Barry, David; Hetts, Steven W; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V; Su, Hua; Saeed, Maythem M

    2015-01-01

    The lack of safe and reliable methods to sample vascular tissue in situ limits discovery of the underlying genetic and pathophysiological mechanisms of many vascular disorders, including aneurysms. We investigated the feasibility and comparable efficacy of in vivo vascular endothelial cell sampling using a spectrum of endovascular devices. Using the rabbit elastase carotid aneurysm model we evaluated the performance of existing aneurysmal coils, intracranial stents, and stent-like devices to collect vascular endothelial cells. Additionally, we modified a subset of devices to assess the effects of alterations to coil pitch, coil wire contour, and stent surface finishing. Device performance was evaluated by (1) the number of viable endothelial cells harvested, (2) the degree of vascular wall damage analyzed using digital subtraction angiography and histopathological analysis, and (3) the ease of device navigability and retrieval. Isolated cells underwent immunohistochemical analysis to confirm cell type and viability. Coil and stent specifications, technique, and endothelial cell counts were tabulated and statistical analysis performed. Using conventional detachable-type and modified aneurysm coils 11 of 14 (78.6%) harvested endothelial cells with a mean of 7.93 (±8.33) cells/coil, while 15 of 15 (100%) conventional stents, stent-like devices and modified stents harvested endothelial cells with a mean of 831.33 (±887.73) cells/device. Coil stiffness was significantly associated with endothelial cell count in univariate analysis (p = 0.044). For stents and stent-like devices univariate analysis demonstrated stent-to-aorta diameter ratios (p = 0.001), stent length (p = 0.049), and the use of a pulling retrieval technique (p = 0.019) significantly predictive of endothelial cell counts, though a multivariate model using these variables demonstrated only the stent-to-aorta diameter ratio (p = 0.029) predictive of endothelial cell counts. Modified

  16. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial.

    PubMed

    Powell, Janet T; Sweeting, Michael J; Thompson, Matthew M; Ashleigh, Ray; Bell, Rachel; Gomes, Manuel; Greenhalgh, Roger M; Grieve, Richard; Heatley, Francine; Hinchliffe, Robert J; Thompson, Simon G; Ulug, Pinar

    2014-01-13

    To assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm. Randomised controlled trial. 30 vascular centres (29 UK, 1 Canadian), 2009-13. 613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm. 316 patients were randomised to the endovascular strategy (275 confirmed ruptures, 174 anatomically suitable for endovascular repair) and 297 to open repair (261 confirmed ruptures). 30 day mortality, with 24 hour and in-hospital mortality, costs, and time and place of discharge as secondary outcomes. 30 day mortality was 35.4% (112/316) in the endovascular strategy group and 37.4% (111/297) in the open repair group: odds ratio 0.92 (95% confidence interval 0.66 to 1.28; P=0.62); odds ratio after adjustment for age, sex, and Hardman index 0.94 (0.67 to 1.33). Women may benefit more than men (interaction test P=0.02) from the endovascular strategy: odds ratio 0.44 (0.22 to 0.91) versus 1.18 (0.80 to 1.75). 30 day mortality for patients with confirmed rupture was 36.4% (100/275) in the endovascular strategy group and 40.6% (106/261) in the open repair group (P=0.31). More patients in the endovascular strategy than in the open repair group were discharged directly to home (189/201 (94%) v 141/183 (77%); P<0.001). Average 30 day costs were similar between the randomised groups, with an incremental cost saving for the endovascular strategy versus open repair of £1186 (€1420; $1939) (95% confidence interval -£625 to £2997). A strategy of endovascular repair was not associated with significant reduction in either 30 day mortality or cost. Longer term cost effectiveness evaluations are needed to assess the full effects of the endovascular strategy in both men and women. Current Controlled Trials ISRCTN48334791.

  17. Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model.

    PubMed

    Oliveira, Jahir Richard DE; Aquino, Maurício DE Amorim; Barros, Svetlana; Pitta, Guilherme Benjamin Brandão; Pereira, Adamastor Humberto

    2016-01-01

    to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent. determinar as alterações do padrão do fluxo sanguíneo após tratamento endovascular do aneurisma sacular de aorta abdominal com triplo stent. estudo hemodinâmico de sete suínos das raças Landrace e Large White portadores de aneurismas saculares de aorta abdominal infrarrenal artificialmente produzidos segundo técnica descrita. Os animais foram submetidos a implante de triplo stent para correção endovascular do aneurisma e reavaliados por duplex scan quanto ao padrão do fluxo sanguíneo antes e após o implante dos stents. A análise estatística foi realizada com o teste Mann-Whitney não pareado. verificou-se uma queda significativa da velocidade sistólica média de 127,4cm/s na fase pré-stent para 69,81cm/s na fase pós-stent. Houve ainda mudança no padrão do fluxo de turbilhonar no saco aneurismático para laminar intrastent. o estudo demonstrou alterações do padrão do fluxo sanguíneo do aneurisma sacular de aorta abdominal após tratamento endovascular com triplo stent.

  18. First Case of Endovascular Treatment of Ruptured Internal Carotid Artery Aneurysm Using Stent Assisted Coiling at the Department of Neurosurgery in Skopje.

    PubMed

    Filipce, Venko; Caparoski, Aleksandar; Milosevic, Zoran

    2015-01-01

    The management of intracranial aneurysms has changed dramatically in recent years. The science and technology advancement have resulted in new therapeutic options for their treatment. There is an increased interest among neurosurgeons to perform endovascular procedures for intracranial aneurysms. This has become a part of the neurosurgical residency in the US. We are presenting our first experience of ruptured aneurysm coiling using stent assisted technique.

  19. Endovascular Surgery for Inflammatory Abdominal Aortic Aneurysm with Contrast Allergy—Usefulness of Carbon Dioxide Angiography and Intravascular Ultrasound: A Case Report

    PubMed Central

    Morito, Haruna; Hoshina, Katsuyuki; Hosaka, Akihiro; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata,, Tetsuro

    2012-01-01

    We report a patient with inflammatory abdominal aortic aneurysm who underwent endovascular aneurysm repair, despite his having an allergy to iodinated contrast medium and anatomy unsuitable for the procedure. Intravascular ultrasound-guided and CO2-assisted aortic stent graft placement was performed, and the procedures resulted in the successful exclusion of the aneurysm with regression of the mantle sign and resolution of hydronephrosis. PMID:23555498

  20. Effect of endovascular and open abdominal aortic aneurysm repair on thrombin generation and fibrinolysis.

    PubMed

    Abdelhamid, Mohamed F; Davies, Robert S M; Vohra, Rajiv K; Adam, Donald J; Bradbury, Andrew W

    2013-01-01

    Abdominal aortic aneurysm (AAA) is associated with a prothrombotic diathesis that may increase the risk of cardiovascular events. This diathesis is exacerbated in the short term by open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR). However, the effect of EVAR and OAR on coagulation and fibrinolysis in the medium and long term is poorly understood. The purpose of this study was to investigate the medium-term effects of EVAR and OAR on thrombin generation, neutralization, and fibrinolysis. Prothrombin fragment (PF)1+2, thrombin antithrombin (TAT) complex, plasminogen activator inhibitor (PAI) activity, and tissue-plasminogen activator (t-PA) antigen were measured in eight age-matched controls (AMCs), 29 patients with AAA immediately before (preoperatively) and 12 months after EVAR (post-EVAR), and in 11 patients at a mean of 16 months after OAR (post-OAR). Preoperatively, PF1+2 levels were significantly higher in patients with AAAs than in AMC. PF1+2 levels post-EVAR and post-OAR were significantly lower than preoperative values and similar to AMC. There was no significant difference in TAT, PAI, or t-PA between AMC, AAA preoperatively, and post-EVAR. Post-OAR, PAI activity was significantly higher than in preoperative patients. AAA is associated with increased thrombin generation without upregulation of fibrinolysis. The prothrombotic, hypofibrinolytic diathesis observed in patients with AAA returns toward normal in the medium term after EVAR and OAR, although there is a trend toward decreased fibrinolysis post-OAR. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  1. Novel use of an endovascular embolectomy device for retrograde suction decompression-assisted clip ligation of a large paraclinoid aneurysm: technical case report.

    PubMed

    Hoh, Daniel J; Larsen, Donald W; Elder, James B; Kim, Paul E; Giannotta, Steven L; Liu, Charles Y

    2008-05-01

    Several different methodologies for proximal occlusion and retrograde suction decompression of large paraclinoid aneurysms have been reported previously. In this article, we describe the novel use of an endovascular embolectomy device (F.A.S.T. funnel catheter; Genesis Medical Interventional, Inc., Redwood City, CA) for temporary internal carotid artery occlusion and suction decompression of an intracranial aneurysm to facilitate surgical clip ligation. The combination of atraumatic occlusion technology and large lumen size makes this technique safer and easier. A 53-year-old woman with progressive headaches underwent computed tomographic angiography, which revealed an unruptured large left paraclinoid aneurysm. Cerebral angiography confirmed the diagnosis. The patient did not tolerate a balloon test occlusion for therapeutic Hunterian internal carotid occlusion. The patient was subsequently taken to the operating room for a craniotomy and clip ligation of the aneurysm. A standard left pterional craniotomy was performed with opening of the sylvian fissure and exposure of the left paraclinoid aneurysm. Intraoperative angiography with introduction of a new endovascular embolectomy device was performed. The device was deployed to achieve temporary occlusion of the cervical internal carotid artery, and aspiration through the central lumen allowed for retrograde suction decompression of the aneurysm. Collapse of the aneurysm through this technique permitted visualization of the aneurysmal neck with successful clip ligation. A new endovascular embolectomy device can be used to safely perform suction decompression of large paraclinoid aneurysms to facilitate clip ligation.

  2. Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance.

    PubMed

    Abada, Hicham T; Sapoval, Marc R; Paul, Jean-François; de Maertelaer, Viviane; Mousseaux, Elie; Gaux, Jean-Claude

    2003-12-01

    The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured.

  3. Brain aneurysm repair

    MedlinePlus

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  4. Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries.

    PubMed

    Garg, Trit; Baker, Laurence C; Mell, Matthew W

    2015-10-01

    The Society for Vascular Surgery recommends annual surveillance with computed tomography (CT) or ultrasonography after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysms. However, such lifelong surveillance may be unnecessary for most patients, thereby contributing to overuse of imaging services. To investigate whether nonadherence to Society for Vascular Surgery-recommended surveillance guidelines worsens long-term outcomes after EVAR among Medicare beneficiaries. We collected data from Medicare claims from January 1, 2002, through December 31, 2011. A total of 9503 patients covered by fee-for-service Medicare who underwent EVAR from January 1, 2002, through December 31, 2005, were categorized as receiving complete or incomplete surveillance. We performed logistic regressions controlling for patient demographic and hospital characteristics. Patients were then matched by propensity score with adjusting for all demographic variables, including age, sex, race, Medicaid eligibility, residential status, hospital volume, ruptured abdominal aortic aneurysms, and all preexisting comorbidities. We then calculated differences in long-term outcomes after EVAR between adjusted groups. Data analysis was performed from January 1, 2002, through December 31, 2011. Post-EVAR imaging modality, aneurysm-related mortality, late rupture, and complications. Median follow-up duration was 6.1 years. Incomplete surveillance was observed in 5526 of 9695 patients (57.0%) who survived the initial hospital stay at a mean (SD) of 5.2 (2.9) years after EVAR. After propensity matching, our cohort consisted of 7888 patients, among whom 3944 (50.0%) had incomplete surveillance. For those in the matched cohort, patients with incomplete surveillance had a lower incidence of late ruptures (26 of 3944 [0.7%] vs 57 of 3944 [1.4%]; P = .001) and major or minor reinterventions (46 of 3944 [1.2%] vs 246 of 3944 [6.2%]; P < .001) in unadjusted analysis. Aneurysm

  5. Physiologically-relevant measurements of flow through coils and stents: towards improved modeling of endovascular treatment of intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; Levitt, Michael; Geindreau, Christian; Rolland Du Roscoat, Sabine; Johnson, Luke; Chivukula, Keshav; Aliseda, Alberto

    2016-11-01

    The hemodynamic environment in cerebral aneurysms undergoing flow-diverting stent (FDS) or coil embolization treatment plays a critical role in long-term outcomes. Standard modeling approaches to endovascular coils and FDS simplify the complex geometry into a homogenous porous volume or surface through the addition of a Darcy-Brinkman pressure loss term in the momentum equation. The inertial and viscous loss coefficients are typically derived from published in vitro studies of pressure loss across FDS and coils placed in a straight tube, where the only fluid path is across the treatment - an unrealistic representation of treatment apposition in vivo. The pressure drop across FDS and coils in side branch aneurysms located on curved parent vessels is measured. Using PIV, the velocity at the aneurysm neck plane is reconstructed and used to determine loss coefficients for better models of endovascular coils or FDS that account for physiological placement and vessel curvature. These improved models are incorporated into CFD simulations and validated against in vitro model PIV velocity, as well as compared to microCT-based coil/stent-resolving CFD simulations of patient-specific treated aneurysm flow.

  6. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

    PubMed Central

    Goodney, Philip P.; Tavris, Dale; Lucas, F. Lee; Gross, Thomas; Fisher, Elliott S.; Finlayson, Samuel R. G.

    2017-01-01

    Introduction Several reports suggest unexpectedly high rates of late abdominal aortic aneurysm (AAA) rupture occur after endovascular AAA repair (EVAR). However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed. Methods We performed a retrospective cohort study of patients undergoing infrarenal AAA repair using information from the Medicare inpatient hospital discharge records (MedPAR files), physician claim files (Part B files, 20% sample), and Medicare Denominator Files for the years 2001 to 2004. Using the Social Security Death Index, we identified all “late” deaths, defined as deaths occurring >30 days and after hospital discharge. We used the National Death Index to identify cause of death information; in particular, those deaths that were likely caused by late rupture. We compared causes of late death and survival between EVAR and open repair using Wilcoxon log-rank and rank-sum tests. Results Between 2001 and 2004, 13,971 patients underwent AAA repair (6119 EVAR, 7852 open repair). After a mean follow-up of 1.6 years in the EVAR cohort and 1.9 years in the open cohort, mortality rates were similar across repair type (15.4% EVAR, 15.9% open repair), with an adjusted odds ratio for death after open repair of 0.98 (95% confidence interval, 0.90–1.07). Of the 2194 documented deaths, 523 occurred before discharge or ≤30 days, and 1671 occurred >30 days and after hospital discharge. Cause of death information for the 1671 late deaths was available from the National Death Index for 1515 (91%). The 15 most common codes for causes of late death were dominated by cardiac disease (atherosclerotic heart disease, acute myocardial infarction) and pulmonary disease (lung cancer, respiratory failure). Causes of late death with specific mention of aneurysm were identified in 37 patients (2.4% of all deaths), but this event was not more common in EVAR or open repair (15 [0.3%] in the EVAR group, 22 [0

  7. Endovascular treatment of intracranial infectious aneurysms in eloquent cortex with super-selective provocative testing: Case series and literature review.

    PubMed

    Fusco, Matthew R; Stapleton, Christopher J; Griessenauer, Christoph J; Thomas, Ajith J; Ogilvy, Christopher S

    2016-04-01

    Intracranial infectious aneurysms (IIAs) are a rare subgroup of intracranial aneurysms. Often erroneously termed mycotic aneurysms, these lesions most often result from infectious endocarditis and involve the distal anterior cortical circulation. Diagnosis typically follows headaches or septic infarcts, although increasing numbers of lesions are found incidentally, during screening protocols for infectious endocarditis. Open surgical treatment was previously the mainstay of treatment; however, these IIAs are often fusiform and quite fragile, making open surgical obliteration difficult and typically requiring lesion trapping. Current treatment techniques more commonly involve endovascular coil embolization or parent vessel occlusion. Many of these lesions occur distally, in or around the eloquent cortex, making embolization potentially dangerous. We present cases that highlight the use of super-selective provocative testing with sodium amobarbital and lidocaine, to help clarify and predict the risk of parent vessel occlusion in IIAs located in the eloquent cortex.

  8. Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

    SciTech Connect

    Coupe, Nicholas J. Ling, Lynn; Cowling, Mark G.; Asquith, John R.; Hopkinson, Gregory B.

    2009-07-15

    We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient's age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.

  9. Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Bianchi, Paolo; Stegher, Silvia; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2006-10-01

    The purpose of this single-institution study was to describe our 7-year intention-to-treat results, obtained with the use of endovascular techniques for the treatment of ruptured abdominal aortic aneurysms (rAAA). From October 1998 until March 2005, a total of 28 patients were admitted or transferred to our department with an rAAA. They were all treated according to a management protocol of intention-to-treat with endovascular techniques. Twenty of the patients received endovascular treatment and the remaining 8 underwent an open surgery procedure. The mortality rate of the endovascularly treated patients was 40% (8 in 20), whereas of the 8 surgical patients 3 survived (mortality = 62.5%). The overall mortality rate of the 28 patients admitted with an rAAA was 46.4% (13 of 28 patients). In our experience the intension-to-treat protocol for rAAA offered acceptable results in terms of mortality rates. Multi-center studies are necessary to establish the role of endovascular treatment in patients with rAAA.

  10. Effect of antiplatelet therapy on aneurysmal sac expansion associated with type II endoleaks after endovascular aneurysm repair.

    PubMed

    Álvarez Marcos, Francisco; Llaneza Coto, José Manuel; Franco Meijide, Francisco José; Zanabili Al-Sibbai, Ahmad Amer; Vilariño Rico, Jorge; Alonso Pérez, Manuel; Caeiro Quinteiro, Santiago

    2017-08-01

    Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) has gained widespread use through a solid reputation of safety and effectiveness. However, some issues, such as endoleaks and sac growth over time, still arise as important concerns. Antiplatelet therapy, mandatory as secondary prevention of cardiovascular disease, may play a role in both phenomena by interfering with blood clotting properties and the inflammatory process associated with AAA. We analyzed whether different antiplatelet therapies were independent risk factors for type II endoleak (T2E) persistence and midterm sac growth after EVAR. All patients with T2E detected in the first post-EVAR control were included, except those without at least 1 year of complete follow-up. Data for demographics, clinical comorbidities, EVAR devices, and antiplatelet therapies were recorded. All patients underwent routine follow-up with contrast-enhanced tomography at 1 month, 6 months, 12 months, and annually thereafter. A three-dimensional rendering of each endoleak was performed for detailed volumetry. Main outcomes were endoleak persistence at 6 months and sac growth >5 mm at end of follow-up. During a 9-year period, 87 patients with initial T2E were monitored for a mean of 41.5 months. On discharge, salicylates were prescribed to 50, clopidogrel to 16, and multiagent therapy or anticoagulation to 9; no therapy was given to 12. No significant differences in comorbidities or baseline AAA characteristics were found between groups. At 6 months thereafter, 59% (n = 51) of the initial T2Es persisted. At end of follow-up, 32 patients had sac growth >5 mm (37%). Sac growth was significantly less frequent in the group treated with salicylates (26% vs 60%; P = .004). Cox proportional hazards model reinforced the role of salicylates as protectors for sac growth over time (hazard ratio, 0.34; 95% confidence interval, 0.13-0.87; P = .024), whereas T2E nidus volume and endoleak complexity behaved

  11. Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note.

    PubMed

    Kubota, Hisashi; Tanikawa, Rokuya; Katsuno, Makoto; Noda, Kosumo; Ota, Nakao; Miyata, Shiro; Yabuuchi, Tomonari; Izumi, Naoto; Bulsara, Ketan R; Hashimoto, Masaaki

    2013-08-01

    Symptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm. To prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft. The patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications. Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

  12. Visceral and Renal Artery Complications of Suprarenal Fixation during Endovascular Aneurysm Repair

    SciTech Connect

    Choke, Edward; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria; Dawson, Joseph; Loftus, Ian M.; McFarland, Robert; Loosemore, Thomas; Thompson, Matthew M.

    2007-07-15

    Background. The effect of suprarenal fixation of endovascular grafts on renal and visceral artery function remains undefined. This study aimed to determine renal and visceral artery complications following suprarenal fixation during endovascular aneurysm repair (EVR). Methods. Prospectively collected data from 112 patients who received suprarenal fixation (group SF) and 36 patients who received infrarenal fixation (group IF) in a single institution from December 1997 to April 2005 were reviewed retrospectively. Median follow-up was 26 months (range 0.1-101 months). Results. Stent struts extended to or above the level of 106 (94.6%) right renal arteries, 104 (92.9%) left renal arteries, 49 (43.8%) superior mesenteric arteries (SMA), and 7 (6.3%) celiac arteries in group SF. This group had 2 (1.8%) unintentional main renal artery occlusions, of which 1 was successfully treated at the first procedure with a renal stent. There was 1 (0.9%) SMA occlusion which resulted in bowel infarction and death. Group IF had no renal or visceral artery complications. There were no late-onset occlusions or infarcts. There was no significant difference in median serum creatinine between groups SF and IF at 1 month (p = 0.18) and 6 months to 12 months (p 0.22) follow-up. The change in serum creatinine over time was also not significantly different within each group (SF, p = 0.09; IF, p 0.38). Conclusions. In this study, suprarenal fixation was associated with a very small incidence of immediate renal and visceral artery occlusion. There did not appear to be any medium-term sequelae of suprarenal fixation.

  13. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

    PubMed

    Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

    2013-12-01

    To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

  14. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Toursavadkohi, Shahab; Kakkos, Stavros K.; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  15. Comparative Effectiveness of Endovascular versus Open Repair of Ruptured Abdominal Aortic Aneurysm in the Medicare Population

    PubMed Central

    Edwards, Samuel T.; Schermerhorn, Marc L.; O’Malley, A. James; Bensley, Rodney P.; Hurks, Rob; Cotterill, Philip; Landon, Bruce E.

    2015-01-01

    Objectives Endovascular abdominal aortic aneurysm repair (EVAR) is increasingly used for emergent treatment of ruptured abdominal aortic aneurysm (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications and rates of re-intervention of EVAR versus open aortic repair of rAAA in Medicare beneficiaries. Methods We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a US hospital from 2001–2008. Patients were propensity score matched on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair and sensitivity analyses were performed to evaluate the impact of bias that might have resulted from unmeasured confounders Results Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality for EVAR and open repair were 33.8% and 47.7% respectively (p<0.001) and this difference persisted for more than four years. EVAR patients had higher rates of AAA-related reinterventions when compared with open repair patients (endovascular reintervention at 36 months 10.9% vs 1.5%, p<0.001), whereas open patients had more laparotomy related complications (incisional hernia repair at 36 months 1.8% vs. 6.2% p<0.001, all surgical complications at 36 months 4.4% vs. 9.1%, p<0.001). Use of EVAR for rAAA has increased from 6% of cases in 2001 to 31% of cases in 2008, while over the same time period overall 30-day mortality for admission for rAAA regardless of treatment has decreased from 55.8% to 50.9%. Conclusions EVAR for rAAA is associated with lower perioperative and long term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized

  16. Are there fewer complications with third generation endografts in endovascular aneurysm repair?

    PubMed

    Jayia, P; Constantinou, J; Morgan-Rowe, L; Schroeder, T V; Lonn, L; Ivancev, K

    2013-02-01

    Endovascular aneurysm repair (EVAR) is widely accepted as a safe technique for treatment of aortic diseases since the concept was first pioneered by Volodos in 1986 and Parodi in 1991. Numerous registries have shown that this minimally invasive technique is associated with lower mortality when compared to open surgery in short and mid-term follow-up. The first pioneer devices had a high failure rate due to stent migration. This led to the creation of the first generation stent-grafts, which were associated with complications such as thrombosis of the limbs, graft migration and major endoleaks. The majority of these endostents are now withdrawn from the commercial market. However, these patients need lifelong surveillance because of a considerable risk of late complications. The materials used in the stent-graft vary with each manufacturer. Low porous fabric, suprarenal fixation and low profile devices led to the development of the second generation stent-grafts. The improvements with regards to the delivery systems, enabled reposition of the top-stent following deployment in some devices. The number of devices commercially available increased with the second generation. The third generation of stent-grafts, allowed treatment of complex aortic disease. Custom made solutions incorporate small openings, fenestrations for vessels involved in the aneurysmal disease and is already built in today's technology and available as CE marked devices. The device can be built with combinations of various branches and fenestrations in order to best accommodate the aortic anatomy of the patient. However, many issues remain with the development of this technology. There is a need for durable systems with less complicated deployment mechanics in order to be applied and more widespread. In conclusion, the third generation endografts in challenging anatomy has yielded encouraging results. With regards to short and midterm outcome and need for secondary interventions, evaluations shows

  17. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    SciTech Connect

    Choke, Edward; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria; Loftus, Ian; McFarland, Robert; Loosemore, Thomas; Thompson, Matthew M.

    2006-12-15

    Purpose. The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy. Methods. Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 deg., circumferential thrombus >50%, and length <10 mm. Eighty-seven patients with 0 adverse features (good necks) were compared with 60 patients with one or more adverse features (hostile necks). Results. Comparing the good neck with the hostile neck group, there were no significant differences in the incidence of primary technical success (p = 0.15), intraoperative adjunctive procedures (p = 0.22), early proximal type I endoleak (<30 days) (p = 1.0), late proximal type I endoleak (>30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04). Conclusion. Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy.

  18. Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes.

    PubMed

    Sethi, Rosh K V; Henry, Antonia J; Hevelone, Nathanael D; Lipsitz, Stuart R; Belkin, Michael; Nguyen, Louis L

    2013-09-01

    The share of total abdominal aortic aneurysm (AAA) repairs performed by endovascular aneurysm repair (EVAR) increased rapidly from 32% in 2001 to 65% in 2006 with considerable variation between states. We hypothesized that hospitals in competitive markets were early EVAR adopters and had improved AAA repair outcomes. Nationwide Inpatient Sample and linked Hospital Market Structure (HMS) data was queried for patients who underwent repair for nonruptured AAA in 2003. In HMS, the Herfindahl Hirschman Index (HHI, range 0-1) is a validated and widely accepted economic measure of competition. Hospital markets were defined using a variable geographic radius that encompassed 90% of discharged patients. We conducted bivariate and multivariable linear and logistic regression analyses for the dependent variable of EVAR use. A propensity score-adjusted multivariable logistic regression model was used to control for treatment bias in the assessment of competition on AAA repair outcomes. A weighted total of 21,600 patients was included in our analyses. Patients at more competitive hospitals (lower HHI) were at increased odds of undergoing EVAR vs open repair (odds ratio, 1.127 per 0.1 decrease in HHI; P < .0127) after adjusting for patient demographics, comorbidities, and hospital level factors (bed size, teaching status, AAA repair volume, and ownership). Competition was not associated with differences in in-hospital mortality or vascular, neurologic, or other minor postoperative complications. Greater hospital competition is significantly associated with increased EVAR adoption at a time when diffusion of this technology passed its tipping point. Hospital competition does not influence post-AAA repair outcomes. These results suggest that adoption of novel vascular technology is not solely driven by clinical indications but may also be influenced by market forces. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  19. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction

    PubMed Central

    Warner, Courtney J.; Horvath, Alexander J.; Powell, Richard J.; Columbo, Jesse A.; Walsh, Teri R.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.

    2017-01-01

    Objective Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. Methods All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Results Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Conclusions Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care

  20. Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticu