| 1. |
- Brunkwall, J., et al.
(författare)
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Endovascular Repair of Acute Uncomplicated Aortic Type B Dissection Promotes Aortic Remodelling: 1 Year Results of the ADSORB Trial
- 2014
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 48:3, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Uncomplicated acute type B aortic dissection (AD) treated conservatively has a 10% 30-day mortality and up to 25% need intervention within 4 years. In complicated AD, stent grafts have been encouraging. The aim of the present prospective randomised trial was to compare best medical treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year. Methods: The AD history had to be less than 14 days, and exclusion criteria were rupture, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB. Results: Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17% of the cases. During the first 30 days, no deaths occurred in either group, but there were three crossovers from the BMT to the BMT TAG group, all due to progression of disease within 1 week. There were two withdrawals from the BMT+TAG group. At the 1-year follow up there had been another two failures in the BMT group: one malperfusion and one aneurysm formation (p = .056 for all). One death occurred in the BMT TAG group. For the overall endpoint BMT+TAG was significantly different from BMT only (p < .001). Incomplete false lumen thrombosis, was found in 13 (43%) of the TAG+BMT group and 30 (97%) of the BMT group (p < .001). The false lumen reduced in size in the BMT+TAG group (p < .001) whereas in the BMT group it increased. The true lumen increased in the BMT TAG (p < .001) whereas in the BMT group it remained unchanged. The overall transverse diameter was the same at the beginning and after 1 year in the BMT group (42.1 mm), but in the BMT+TAG it decreased (38.8 mm; p = .062). Conclusions: Uncomplicated AD can be safely treated with the Gore TAG device. Remodelling with thrombosis of the false lumen and reduction of its diameter is induced by the stent graft, but long term results are needed. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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| 2. |
- Dias, Nuno, et al.
(författare)
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Commentary: "Aneurysm Sac Pressure after EVAR"
- 2007
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 34:4, s. 41-432
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Tidskriftsartikel (refereegranskat)abstract
- Abstract is not available
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| 3. |
- Dias, Nuno, et al.
(författare)
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Complicated Acute Type B Dissections-An 8-years Experience of Endovascular Stent-graft Repair in a Single Centre.
- 2006
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 31:5, s. 481-486
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To analyze the experience of a single centre using stent-grafts for treatment of complicated acute aortic type B-dissections (EVR-ABD). Design. Retrospective analysis of prospectively collected data from patients undergoing EVR-ABD between January 1997 and December 2004. Methods. EVR-ABD was performed in 31 patients (20 males, median age 74. years (IQR: 64-79)). Indications for treatment were aortic rupture (22 patients), intractable pain and hypertension (six patients), acute bowel ischemia (two patients) and transient paraplegia, lower limb and renal ischemia in one patient. Initially home-made devices (five patients) and subsequently commercially available thoracic stent-grafts were used. Results. Five patients (16%) died within 30 days of EVR-ABD. Postoperative complications occurred in 15 (48%) patients, including one paraplegia converted to paraparesis after cerebrospinal fluid drainage, five strokes, three lower limb ischemia, three myocardial infarction, two pneumonia and one colitis). Re-interventions were required in nine patients (29%). Six more deaths occurred during a median follow-up of 22 (IQR: 16-34) months, two related to the stent-graft and four due to cardiac disease. Conclusions. Stent-graft repair of complicated acute type B dissections seems to provide acceptable results and, therefore, it may be considered a valuable alternative to open surgery.
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| 4. |
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| 5. |
- Dias, Nuno, et al.
(författare)
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EVAR of Aortoiliac Aneurysms with Branched Stent-grafts.
- 2008
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 35, s. 677-684
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Branched iliac stent-grafts (bSG) have recently been developed in order to preserve internal iliac artery (IIA) flow in patients with aneurysmal or short common iliac arteries. The aim of this study is to evaluate a single-center experience with bSG for the IIA. METHODS: Twenty-two male patients (70 (IQR 65-79) years old) underwent EVAR with 23 bSG (1 bilateral repair) between September 2002 and August 2007. Median AAA diameter was 52 (37-60) mm while common iliac diameter on the side of the bSG was 34 (27-41) mm. Two in-house modified Zenith SG and subsequently 21 commercially available bSG (18 Zenith Iliac Side and 3 Helical Branches) were used. Follow-up (FU) included CT at one month and yearly thereafter. Data was prospectively entered in a database. RESULTS: Primary technical success was 91% (21 bSG). Median FU duration was 20 (8-31) months. One patient (5 %) died after discharge from acute myocardial infarction on day 13. Another patient died 30 months after EVAR of an unrelated cause. The overall bSG patency was 74% due to 6 branch occlusions (2 intraoperative and 4 late). All patients with patent bSG were asymptomatic. Three occlusions were asymptomatic findings on CT, while the other three developed claudication (two patients with contralateral IIA occlusion and one with simultaneous occlusion of the external iliac). One patient (5%) developed an asymptomatic type III endoleak at 1 month and was successfully treated with a bridging SG. Overall, four patients (18%) required reinterventions (1 bilateral stenting of the external iliac arteries, 1 external and 1 internal SG extensions and 1 femoro-femoral cross-over bypass). Nine out of 16 patients (56%) with CT-FU>/=1 year had shrinking aneurysms. There were no postoperative aneurysm expansions. CONCLUSIONS: EVAR of aortoiliac aneurysms with IIA bSG is a good alternative to occlusion of the IIA in patients with challenging distal anatomy.
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| 6. |
- Dias, Nuno, et al.
(författare)
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Intra-aneurysm Sac Pressure in Patients with Unchanged AAA Diameter after EVAR.
- 2010
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 39, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study intra-aneurysm sac pressure and subsequent abdominal aortic aneurysm (AAA) diameter changes in patients without endoleaks that remain unchanged in AAA diameter more than 1 year after endovascular aneurysm repair (EVAR). METHODS: A total of 23 patients underwent direct intra-aneurysm sac pressure (DISP) measurements 16 months (IQR: 14-35 months) after EVAR. Tip-pressure sensors were used through translumbar AAA puncture. Mean pressure index (MPI) was calculated as the percentage of mean intra-aneurysm pressure relative to the simultaneous mean intra-aortic pressure. Aneurysm expansion or shrinkage was assumed whenever the diameter change was >/=5mm. Values are presented as median and interquartile range. RESULTS: In 18 patients, no fluid was obtained upon AAA puncture (group A). In five patients, fluid was obtained (group B). In group A, follow-up continued for 29 months (IQR: 15-35 months) after DISP; five AAAs shrank, 10 remained unchanged and three expanded (MPIs of 26% (IQR: 18-42%), 28% (IQR: 20-48%) and 63% (IQR: 47-83%) and intra-sac pulse pressures of 3mmHg (IQR: 0-5mmHg), 4mmHg (IQR: 2-8mm Hg) and 12mmHg (IQR: 6-20mmHg), respectively, for the three subgroups). MPI and intra-sac pulse pressures were higher in AAAs that subsequently expanded (P=0.073 and 0.017, respectively). MPI and pulse pressure correlated with total diameter change (r=0.49, P=0.039 and r =0.39, P=0.109, respectively). Pulse pressure had a greater influence than MPI on diameter change (R(2)=0.346, P=0.041, beta standardised coefficient of 0.121 for MPI and 0.502 for pulse pressure). Similar results with stronger, and significant correlation to pulse pressure were obtained when relative diameter changes were used (r=0.55, P=0.017). In group B, MPI and AAA pulse pressure were 32% (IQR: 18-37%) and 1mmHg (IQR: 0-6mmHg), respectively. After 36 months (IQR: 21-38 months), one AAA shrank, three continued unchanged while one expanded. CONCLUSIONS: AAAs without endoleak and unchanged diameter more than 1 year after EVAR will often continue unchanged. Expansion can eventually occur in the absence of intra-sac fluid accumulation and is associated with higher and more pulsatile intra-sac pressure. However, in patients with intra-sac fluid, expansion can occur with low intra-sac pressures.
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| 7. |
- Dias, Nuno, et al.
(författare)
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Is There a Benefit of Frequent CT Follow-up After EVAR?
- 2009
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; Feb 20, s. 425-430
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR. METHODS: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58mm (IQR: 53-67mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR. All patients received Zenith stent-grafts for non-ruptured AAAs at a single institution. Patients were considered asymptomatic when a re-intervention was done solely due to an imaging FU finding. The data were prospectively entered in a computer database and retrospectively analysed. RESULTS: As a follow-up, 1167 CT scans were performed at a median of 54 months (IQR: 34-74 months) after EVAR. Twenty-seven patients exhibited postoperative AAA expansion (a 5-year expansion-free rate of 88+/-2%), and 57 patients underwent 78 postoperative re-interventions with a 5-year secondary success rate of 91+/-2%. Of the 279 patients, 26 (9.3%) undergoing imaging FU benefitted from the yearly CT scans, since they had re-interventions based on asymptomatic imaging findings: AAA diameter expansion with or without endoleaks (n=18), kink in the stent-graft limbs (n=4), endoleak type III due to stent-graft limb separation without simultaneous AAA expansion (n=2), isolated common iliac artery expansion (n=1) and superior mesenteric artery malperfusion due to partial coverage by the stent-graft fabric (n=1). CONCLUSIONS: Less than 10% of the patients benefit from the yearly CT-FU after EVAR. Only one re-intervention due to partial coverage of a branch by the stent-graft would have been delayed if routine FU had been based on simple diameter measurements and plain abdominal radiograph. This suggests that less-frequent CT is sufficient in the majority of patients, which may simplify the FU protocol, reduce radiation exposure and the total costs of EVAR. Contrast-enhanced CT scans continue, nevertheless, to be critical when re-interventions are planned.
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| 8. |
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| 9. |
- Holst, Jan, et al.
(författare)
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Early and Intermediate Outcome of Emergency Endovascular Aneurysm Repair of Ruptured Infrarenal Aortic Aneurysm: A Single-Centre Experience of 90 Consecutive Patients.
- 2009
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 37, s. 413-419
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the early and intermediate outcome of a consecutive series of emergency endovascular aneurysm repairs (eEVAR) of computed tomography (CT)-verified infrarenal ruptured abdominal aortic aneurysm (rAAA) at a single tertiary referral centre. METHODS: Prospectively collected data of patients operated between April 2000 and October 2007 were retrospectively reviewed and all their pre-, intra- and postoperative imaging were re-evaluated. Patient and procedural data were analysed using a Cox multiregression model. RESULTS: Ninety patients (86% men, aged 76 (+/-7) years), were identified and included in the analysis. Symptom duration was <3h in 22% of patients, 3-24h in 39% and >24h in 39%. Mean aneurysmal diameter was 73 (+/-14)mm. All patients were treated with the COOK Zenith((R)) stent-graft (56% bi-iliac and 44% uni-iliac). Sixty-one percent were haemodynamically unstable on presentation, and 26% required an intra-operative aortic occlusion balloon to maintain haemodynamic stability. The 30-day and 1-year mortality rates were 27% and 37%, respectively. One-year aneurysm-related mortality was 33%. Twenty-eight percent of patients required re-interventions during the follow-up. The use of an aortic occlusion balloon and the presence of cerebrovascular disease or obstructive lung disorder correlated significantly with 30-day mortality in the multivariate analysis. CONCLUSION: EVAR is a valid treatment option for rAAA when used as a first-line method for all patients.
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| 10. |
- Lindblad, Bengt, et al.
(författare)
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Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data.
- 2015
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 50:6, s. 722-731
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Forskningsöversikt (refereegranskat)abstract
- The chimney graft (CG) technique was introduced to rescue accidentally covered aortic branches during aortic endovascular repair. It extends the sealing zone. There is concern about "gutter" type I endoleak (EL-I) and about the durability of CGs. The aim of the present report was to analyze the rapidly increasing existing data.
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