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- Prendes, Carlota Fernandez, 1989-
(author)
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Endovascular Treatment of Complex Aortic Pathologies – The Importance of Adequate Patient Selection and Thorough Evaluation of Novel Techniques
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Aortic pathologies include a broad spectrum of diseases, whose inci-dence, prevalence and mortality typically increases with age. Traditional-ly, open surgery was the only viable treatment solution. However, endo-vascular repair has revolutionized aortic treatment, with ever-increasing available devices, more developed techniques, and improved patient outcomes. The combination of an aging population and improving out-comes has led to an ever-increasing number of patients being offered - and ultimately undergoing – treatments, for which 20 years ago they would have been considered too “high-risk”. The past years have also seen significant strides in innovation and technical device feasibility. However, in conjunction with the development of new systems and technologies, an increase in the number of device recalls from the mar-ket has occurred. Is the broadening of patient selection criteria and novel devices really associated with improved outcomes? As these techniques continue to break new boundaries, adequate patient selection and thor-ough assessment of novel technologies becomes only more vital.The aim of this PhD is therefore to 1) evaluate the effect of age on the outcomes of aortic endovascular treatment; and 2) to expand our knowledge of outcomes following the implementation of novel technolo-gies used for endovascular aortic treatments.
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| 2. |
- Zuccon, Gianmarco, et al.
(author)
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Incidence, Risk Factors, and Prognostic Impact of Type Ib Endoleak Following Endovascular Repair for Abdominal Aortic Aneurysm : Scoping Review
- 2023
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 66:3, s. 352-361
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Research review (peer-reviewed)abstract
- Objective: The primary objectives of this scoping review were to assess the rate of and risk factors for type Ib endoleak and to evaluate the extent of the evidence base that links type Ib endoleak to short and long term outcomes in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).Methods: Potentially eligible studies were searched in the Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science Core Collection, SciELO Citation Index, Russian Science Citation Index, and KCI-Korean Journal Database. A scoping review was performed according to PRISMA extension for Scoping Reviews.Results: A total of 27 articles (four prospective registries and 23 retrospective cohort studies) dealing with type Ib endoleak were included in the final analysis. The number of patients reported on was 7 197, with follow up ranging between 12 months and 93 months. The reported frequency of type Ib endoleak in patients treated with EVAR ranged from 0% to 8%, Patient and or procedure related factors associated with risk of type Ib endoleak were (1) common iliac artery (CIA) diameter ˃ 18 mm requiring use of flared stent graft limbs (FLs) ˃ 20 mm, (2) length of CIA landing zone ˂ 20 mm, (3) marked iliac tortuosity, and (4) large initial AAA diameter. Depending on the study, 50 – 100% of type Ib endoleaks were corrected by endovascular means, with a reported immediate technical success of 100% in the studies providing this information.Conclusion: Type Ib endoleak after EVAR has been reported to occur in 0 – 8% of cases. Several anatomical features, including CIA diameter ˃ 18 mm or requiring the use of FLs ˃ 20 mm, length of CIA landing zone ˂ 20 mm, marked iliac tortuosity, and large initial AAA diameter, could increase the risk of type Ib endoleak and may require alternative therapeutic options and or more stringent follow up. Therefore, this updated scoping review provides a comprehensive summary of the frequency, risk factors, prognosis, and treatment of type Ib endoleaks, and has identified knowledge gaps in the literature to guide further studies.
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