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Sökning: WFRF:(Kristmundsson T.)

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  • Abdulrasak, M., et al. (författare)
  • The Long-term Durability of Intra-operatively Placed Palmaz Stents for the Treatment of Type Ia Endoleaks After EVAR of Abdominal Aortic Aneurysm
  • 2017
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 53:1, s. 69-76
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective/Background The objective was to analyze the long-term durability of intra-operatively placed Palmaz stents for type Ia endoleaks, and the evolution of aneurysm neck morphology. Methods This was a retrospective cohort study conducted at a tertiary referral centre. Patients treated between 1998 and 2012 were reviewed with regard to pre-, intra-, and post-operative data. Crude and relative survival estimates were calculated, with the latter referring only to patients with ≥ 3 months’ follow-up. Results In total, 125 patients were included (83 elective, 22 ruptures, 20 symptomatic). Nine patients died perioperatively (two elective, seven acute). Median follow-up was 43 months (range 15–72). Seven patients had late abdominal aortic aneurysm related deaths. There were 51 re-interventions (seven type Ia endoleak related). Five year crude primary, primary assisted, and secondary success rates were 55 ± 5%, 66 ± 5%, and 70 ± 5%, respectively. These crude rates were superior for elective patients (p = .008, p = .031, and p = .037, respectively), but the relative rates were not (p = .187, p = .640, p = .558, respectively). Primary and assisted freedom from type Ia endoleak 5 years post-operatively were 84 ± 4% and 89 ± 3%, respectively. These rates were superior in elective patients (p = .066 and p = .145, respectively), especially when relative rates were analysed (p = .025 and p = .063, respectively). The visceral aortic diameter increased significantly between the first and the last post-operative imaging in 15/91 (16%), 12/91 (13%), 34/91 (37%), and 30/91 (33%) patients at the levels of coeliac trunk, superior mesenteric artery, lowest renal artery, and 9 mm distal to lowest renal artery, respectively. Conclusion Intra-operatively placed Palmaz stents confer high long-term freedom from type Ia endoleak. Palmaz stents are an acceptable intra-operative bailout tool in the acute setting, but should not be used to extend elective infrarenal endovascular aneurysm repair to more demanding anatomies.
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  • Asciutto, G., et al. (författare)
  • Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results
  • 2017
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 54:4, s. 472-479
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective/Background The objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the “pave and crack” technique during endovascular aneurysm repair (EVAR) of varying complexity. Methods This was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality. Results Nineteen patients underwent EVAR with EC (16 juxtarenal or thoraco-abdominal, two infrarenal and one thoracic; four were ruptured). Fourteen patients (73.7%) had TASC D lesions. In 10 cases (52.6%) adjunctive open/endovascular procedures to improve the femoral outflow were required. EC was technically successful in all cases and all EC were patent at EVAR completion. Thirty day mortality occurred in two cases (10.5%) One of these patients had been treated for rupture. One patient required two endovascular re-interventions at 1 and 5 years post-operatively to restore patency of the EC. No open re-interventions related to the EC were necessary. After a median follow-up period of 17 (interquartile range 5–37) months, the primary assisted patency of the EC was 88.9% (SE 10.5). No new onset of claudication or lower limb amputations occurred during the follow-up. Conclusion EC allows EVAR of varying complexity without the need for open surgical ilio-femoral conduits in patients with concomitant advanced iliac occlusive disease. Intra-operative haemodynamic instability was always avoided and mid-term patency was high.
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  • Resch, Tim, et al. (författare)
  • Off-the-shelf options for juxtarenal and pararenal aortic aneurysm
  • 2011
  • Ingår i: Italian Journal of Vascular and Endovascular Surgery. - 1824-4777. ; 18:4, s. 249-256
  • Forskningsöversikt (refereegranskat)abstract
    • In patients unsuitable for standard, infrarenal endovascular aneurysm repair (EVAR) due to an inadequate or inappropriate infrarenal neck, various options have been proposed to achieve a suitable endovascular repair. The primary objective in this setting is to move the endograft sealing zone to a healthier, more cranial segment of the aorta. The need for a solution for problematic proximal neck anatomy in an urgent fashion, can be heightened in the setting of extremely large or symptomatic aneurysms. Chimney techniques and physician modified stent-grafts are transitional techniques utilizing standard endovascular inventory to treat complex aneurysms. However, development of off-the-shelf stent-grafts to accommodate for the majority off pararenal aneurysms is rapidly increasing and the initial clinical experience is promising.
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