| 1. |
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| 2. |
- Chuter, Timothy A M, et al.
(författare)
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A telescopic stent-graft for aortoiliac implantation
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To test a new delivery system for a telescopic stent-graft. MATERIALS: Variable overlap between the components of this stent-graft combination allows length adjustment. This device differs from other multi-component stent-grafts in that both components are contained within a single delivery system. METHODS: The stent-graft was implanted in the distal thoracic to suprarenal aorta of five pigs (35-50 kg), where the arterial diameter falls by almost 50%. The proximal and distal components of the stent-graft were targeted to bony landmarks in the vertebral column. RESULTS: Inspection of completion angiograms showed both proximal and distal stent-grafts to be within 1 mm of their target locations in all five experiments. Overall combined stent-graft length varied from 13.5 cm to 16.1 cm depending on the location of the bony landmark chosen as the distal target, and on the size of the pig. CONCLUSIONS: This system may be useful for the repair of abdominal aortic aneurysm whenever preoperative sizing is difficult due to aortic tortuosity, or precluded due to the urgency of the procedure.
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| 3. |
- Chuter, Timothy A M, et al.
(författare)
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Aneurysm pressure following endovascular exclusion
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 85-87
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the effect of stent-graft implantation on the pressure within an abdominal aortic aneurysm. METHODS: Aneurysm exclusion was performed using an aorto-uniiliac stent-graft in eight patients. Following stent-graft implantation, pressure measurements were performed through a catheter adjacent to the graft in the aneurysm. This "aneurysm pressure" was compared with radial arterial pressure. RESULTS: The pressure was lower in the aneurysm than in the radial artery, in all cases. Mean aneurysm pressure was 36.5/33.8 mmHg, while mean radial arterial pressure was 118.5/50.5 mmHg (p < 0.05, for both systolic and diastolic pressures). These findings corresponded with a reduction in the palpable abdominal pulse, and an absence of perigraft perfusion on follow-up computerised tomography. CONCLUSION: Stent-graft implantation produces a fall in the pressure within an abdominal aortic aneurysm.
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| 4. |
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| 5. |
- Greenberg, R, et al.
(författare)
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Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms
- 1998
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Ingår i: European Journal of Radiology. - 1872-7727. ; 28:3, s. 211-218
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated.
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| 6. |
- Ivancev, Krassi, et al.
(författare)
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Abdominal aortic aneurysms: experience with the Ivancev-Malmo endovascular system for aortomonoiliac stent-grafts
- 1997
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 4:3, s. 242-251
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. METHODS: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Iancev-Malmo system. RESULTS: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. CONCLUSIONS: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.
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| 7. |
- Ivancev, Krassi, et al.
(författare)
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Options for treatment of persistent aneurysm perfusion after endovascular repair
- 1996
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 20:6, s. 673-678
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Tidskriftsartikel (refereegranskat)abstract
- Persistent aneurysm perfusion represents failure of endovascular repair. The leak may occur around either end of the prosthesis or through a collateral route. Most cases can be treated by endovascular means. Stents can be rotated, the prosthesis can be lengthened at either end, and collateral pathways can be occluded, all without recourse to open repair. This report describes the management of persistent aneurysm perfusion in five patients from a total experience of 32 cases of endovascular aneurysm repair.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Malina, Martin, et al.
(författare)
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Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion
- 1997
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 4:1, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors. METHODS: Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12). RESULTS: At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion. CONCLUSIONS: The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.
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| 12. |
- Malina, Martin, et al.
(författare)
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Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:4, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta. METHODS: Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force. RESULTS: The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects. CONCLUSIONS: Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.
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| 13. |
- Malina, Martin, et al.
(författare)
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Endovascular management of the juxtarenal aortic aneurysm: can uncovered stents safely cross the renal arteries?
- 1999
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Ingår i: Seminars in Vascular Surgery. - 0895-7967. ; 12:3, s. 182-192
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Tidskriftsartikel (refereegranskat)abstract
- A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be improved by placing the proximal stent above one or both of the renal artery orifices. Current experimental and clinical data suggest that renal function is not impaired by suprarenal aortic stents during the first year; however, this finding may not apply to all types of stents. Fixation of stent-grafts also may be improved by using stents with barbs that pierce the aortic wall. Additionally, the force that is exerted on the anchoring device may well be reduced by fully stented grafts with an associated increase in column strength. In the future, the risk of neck dilation and stent-graft dislodgement might also be limited by novel techniques such as laparoscopic banding of the neck or endoluminal stapling devices.
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| 14. |
- Malina, Martin, et al.
(författare)
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Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:3, s. 274-277
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe a fatal case of late aortic perforation by an endograft-anchoring stent. METHODS AND RESULTS: A 69-year-old woman presented 2 years after thoracoabdominal aneurysm repair with a 9-cm dilatation of the descending thoracic aorta proximal to the conventional aortic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutured inside was placed transluminally across the aortic arch such that part of the uncovered portion of the proximal stent was partially across the left subclavian orifice. Four months later, the patient died from massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch. CONCLUSIONS: This case stresses the need for low-profile stent-grafts and smaller, more flexible introducer systems. Anchoring stents must be flexible, less traumatic, and strong enough to create a watertight seal even in tortuous vessels. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered by the fabric.
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| 15. |
- Malina, Martin, et al.
(författare)
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Reduced pulsatile wall motion of abdominal aortic aneurysms after endovascular repair
- 1998
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Ingår i: Journal of Vascular Surgery. - 1097-6809. ; 27:4, s. 624-631
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The reduced size of abdominal aortic aneurysms (AAAs) after endovascular repair suggests lowered intraaneurysmal pressure. In the presence of endoleaks, the size is not decreased. Although postoperative intraaneurysmal pressure is difficult to record, the pulsatile wall motion (PWM) of aneurysms can be measured noninvasively. The aim of this study was to assess the PWM of AAAs before and after endovascular repair and to relate the change in the PWM to aneurysmal size and presence of endoleaks. METHODS: Forty-seven patients underwent endovascular repair of an AAA. The aneurysm diameter and PWM were measured with the use of ultrasonic echo-tracking scans preoperatively; at 1, 3, and 6 months; and thereafter biannually. Fifteen aneurysms developed endoleaks, whereas 32 were completely excluded. The leaks were characterized with the use of computed tomographic scanning and angiography. Median follow-up was 12 months (interquartile range, 5 to 24 months). RESULTS: The preoperative PWM of the aneurysms was 1.0 mm (range, 0.8 to 1.3 mm). After complete endovascular exclusion, the PWM was 25% (range, 16% to 37%) of the preoperative value (p < 0.001), and aneurysm diameter decreased by 8 mm (range, 6 to 14 mm) (p < 0.001). After 18 months, no further diameter reduction occurred. In three patients without endoleaks but with enlarging aneurysms, the postoperative PWM showed less reduction (p < 0.05). Aneurysms with endoleaks showed no diameter decrease, and the postoperative PWM was 50% higher than that in the totally excluded cases (p < 0.01). In five patients with transient endoleaks, the PWM was reduced after leakage ceased (p < 0.05). Leaks of various sources displayed similar PWM. CONCLUSION: The size and PWM of aneurysms are reduced after endovascular repair. The diameter reduction may cease after 1.5 years. Endoleaks are associated with higher PWM than expected. Pressure may be transmitted without evidence of leaks.
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| 16. |
- Malina, Martin, et al.
(författare)
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Renal arteries covered by aortic stents: clinical experience from endovascular grafting of aortic aneurysms
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 14:2, s. 109-113
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: During the endovascular repair of abdominal aortic aneurysms (AAAs), effective anchoring of the stent-graft is difficult in the presence of a short infrarenal aneurysm neck. The aim of this study was to investigate renal artery patency and renal function after deployment of graft anchoring stents across the renal arteries. DESIGN: Retrospective open study. PATIENTS: Twenty-five renal arteries, in 18 patients treated by endovascular exclusion of an AAA, were intentionally covered with the Gianturco Z-stent to ensure stent graft attachment. METHODS: Renal artery patency was assessed by repeated spiral computed tomography (CT) scans and angiography. Creatinine levels, blood pressure and antihypertensive medication were recorded. Follow-up was a median 6 months (2-9). RESULTS: All 25 stent-covered renal arteries remained patent. CT showed a small infarct in one kidney. Creatinine was 108 mumol/l (89-133) before intervention and 98 mumol/l (87-127) at follow-up. Blood pressure was 150/80 mmHg on both occasions. Antihypertensive therapy was intensified in one patient whose creatinine level remained stable and whose separate renin sampling was normal. CONCLUSIONS: Covering the renal arteries with the Gianturco Z-stent does not seem to affect renal function within 6 months. Further follow-up is needed before suprarenal stent deployment can be advocated.
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| 17. |
- Malina, Martin, et al.
(författare)
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The effect of endovascular aortic stents placed across the renal arteries
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:2, s. 207-213
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate renal artery patency and renal function after deployment of aortic stents covering the orifices of renal arteries. DESIGN: Prospective open animal study. SETTING: Department of Experimental Surgery at a university hospital. MATERIALS: Twenty-three pigs were used. METHODS: Ten pigs were observed for 1 h after graft-anchoring aortic stents, Gianturco (5) and Palmaz (5), were placed so that the stents covered the renal arterial orifices. In 13 pigs, Gianturco (6) and Palmaz (7) stents without grafts were placed over the renal arteries and left in situ for 7 days. Renal function and blood flow were measured by renograms, iohexol clearance and ultrasonic blood flow meter and patency was verified by angiograms. The kidneys were microscopically examined for signs of ischaemia and microemboli. RESULTS: One renal artery covered by a graft-anchoring Gianturco stent occluded. The remaining renal arteries remained patent without any significant decrease in renal blood flow after stent deployment. Normal renal function and histology was maintained. CONCLUSIONS: Aortic stents placed at the level of the renal arteries do not affect renal blood flow within 1 week in this experimental model. This may prove valuable in endovascular treatment of aortic aneurysms and in other procedures involving stents.
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| 18. |
- Nyman, Ulf, et al.
(författare)
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Chronic aortic dissection: stenting of aortic true lumen obliteration with late dynamic variations of both lumens
- 1999
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 1432-086X .- 0174-1551. ; 22:2, s. 135-149
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Tidskriftsartikel (refereegranskat)abstract
- Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.
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| 19. |
- Nyman, Ulf, et al.
(författare)
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Endovascular treatment of chronic mesenteric ischemia: report of five cases
- 1998
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 1432-086X .- 0174-1551. ; 21:4, s. 305-313
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the midterm results of percutaneous transluminal angioplasty (PTA) and stent placement in stenotic and occluded mesentesic arteries in five consecutive patients with chronic mesenteric ischemia. METHODS: Five patients with 70%-100% obliterations of all mesenteric vessels resulting in chronic mesenteric ischemia (n = 4) and as a prophylactic measure prior to abdominal aortic aneurysm repair (n = 1) underwent PTA of celiac and/or superior mesenteric artery (SMA) stenoses (n = 2), primary stenting of ostial celiac occlusions (n = 2), and secondary stenting of a SMA occlusion (n = 1; recoil after initial PTA). All patients underwent duplex ultrasonography (US) (n = 3) and/or angiography (n = 5) during a median follow-up of 21 months (range 8-42 months). RESULTS: Clinical success was obtained in all five patients. Asymptomatic significant late restenoses (n = 3) were successfully treated with repeat PTA (n = 2) and stenting of an SMA occlusion (n = 1; celiac stent restenosis). Recurrent pain in one patient was interpreted as secondary to postsurgical abdominal adhesions. Two puncture-site complications occurred requiring local surgical treatment. CONCLUSIONS: Endovascular techniques may be attempted prior to surgery in cases of stenotic or short occlusive lesions in patients with chronic mesenteric ischemia. Surgery may still be preferred in patients with long occlusions and a low operative risk.
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| 20. |
- Nyman, Ulf, et al.
(författare)
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Kronisk mesenteriell ischemi. Endovaskulär behandling lika effektiv som öppen kirurgi
- 1998
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Ingår i: Läkartidningen. - 0023-7205. ; 95:36, s. 3785-3790
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Tidskriftsartikel (refereegranskat)abstract
- Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).
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| 21. |
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| 22. |
- Resch, Tim, et al.
(författare)
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Abdominal aortic aneurysm morphology in candidates for endovascular repair evaluated with spiral computed tomography and digital subtraction angiography
- 1999
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 6:3, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair. METHODS: Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison. RESULTS: Mean maximum AAA diameter was 58 +/- 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 +/- 3.6 mm versus 23.0 +/ 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = -0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length. CONCLUSIONS: AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.
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| 23. |
- Resch, Tim, et al.
(författare)
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Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms
- 1999
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Ingår i: Journal of Vascular and Interventional Radiology. - 1051-0443. ; 10:3, s. 257-264
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze patients after endovascular repair of abdominal aortic aneurysm (AAA) with respect to distal migration of stent-grafts and its underlying causes. MATERIALS AND METHODS: Sixty-five patients underwent endovascular repair between January 1994 and February 1997. There were seven women and 58 men, with a mean age of 71 years (range, 51-84 years). Three patients died in the perioperative period (one of myocardial infarction and two of multiorgan failure) and two patients died within 4 months of the procedure of non-procedure-related causes. In addition, two patients were followed at another hospital. The remaining 58 patients were followed up with spiral computed tomography scans at 1, 3, and 6 months, and biannually thereafter. Angiography was performed at 1 month and 1 year after the procedure and additionally when deemed clinically necessary. Mean follow-up was 29 months (range, 1-49). Migration more than 5 mm was considered significant. RESULTS: Twenty-six patients (45%) showed distal migration of stent-grafts during follow-up. Mean follow-up time at detection of migration was 13 months (range, 1-36 months). Thirteen cases of migration were ascribed to dilatation of the proximal aneurysmal neck during follow-up. Ten cases of migration were ascribed to causes other than neck dilatation or poor patient selection. In three cases, no obvious cause for the migration was found. The migration was complete in eight cases, leading to late conversion to open surgical repair. On two of these occasions, complete migration lead to aneurysm rupture. In addition, four patients received additional stent-grafts as proximal extensions. CONCLUSIONS: Distal migration of stent-grafts after endovascular AAA repair occurred frequently in this series. Dilatation of the proximal aneurysmal neck is a major cause of distal migration of stent-grafts. Improved proximal fixation is needed to secure long-term durability.
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| 24. |
- Resch, Tim, et al.
(författare)
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Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter
- 1998
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Ingår i: Journal of Vascular Surgery. - 1097-6809. ; 28:2, s. 242-249
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To differentiate between the phenomenon of collateral perfusion from a side branch versus graft-related endoleaks after endovascular repair of abdominal aortic aneurysms (AAA), with respect to aneurysm size and prognosis. METHODS: We successfully treated 64 AAA patients with endovascular grafting. We followed all the patients postoperatively with spiral computed tomography at one, three, six and 12 months, and biannually thereafter. We measured aneurysm diameters preoperatively and postoperatively. We calculated preoperatively the relation of maximum aortic diameter (D) to the thrombus-free lumen diameter (L) expressed as an L/D ratio. Median follow-up was 15 months. RESULTS: Sixteen patients had collateral perfusion during follow-up. We successfully treated two patients with embolization. One patient showed resolution of collateral perfusion after we stopped warfarin treatment. Two patients died of unrelated causes during follow-up. One patient was converted to surgical treatment, and two patients showed spontaneous resolution of their collateral perfusion. The group of patients with perfusion showed no statistically significant change of their aortic diameter on follow-up. The group of patients without perfusion showed a median decrease in aortic diameter of 8mm (p < 0.0001) at 18 months postoperatively. The group of patients with perfusion had significantly less thrombus in their aneurysm sac preoperatively than the group without perfusion, as expressed by the L/D ratio (mean L/D 0,61 versus 0,78, respectively; p=0.0021.) CONCLUSION: There was no significant increase in aortic diameter on an average 18 months postoperatively despite persistent collateral perfusion. This may indicate a halted disease progression in the short term. Embolization of collateral vessels is associated with risk of paraplegia. We recommend a conservative approach with close observation if aneurysm diameter is stable.
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| 25. |
- Sonesson, Björn, et al.
(författare)
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Dilatation of the infrarenal aneurysm neck after endovascular exclusion of abdominal aortic aneurysm
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:3, s. 195-200
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine the fate of the infrarenal aneurysm neck and suprarenal aorta after endovascular exclusion of abdominal aortic aneurysms (AAAs). METHODS: Thirty-four patients underwent endovascular AAA repair between January 1994 and December 1995 using custom-made stent-grafts constructed from polyester graft material and modified self-expanding Gianturco Z-stents sutured to the graft orifices. Thirty-one patients were available for follow-up. Pre- and postimplantation diameters were measured using spiral computed tomography in the infrarenal aneurysm neck and the suprarenal aorta at the level of the superior mesenteric artery (SMA). RESULTS: The mean follow-up time was 25 months. There was a significant increase of the diameter of the infrarenal aneurysm neck (+ 1.65 mm, p = 0.002), but not in the aorta at the level of the SMA (+0.52 mm, p = 0.100). There was no difference in the change in diameter in the infrarenal neck in the group with a stent adjacent to the level of measurement (n = 20) compared with the group without an adjacent stent (n = 11, p = 0.790). There was no correlation between preimplantation size of the infrarenal neck and its diameter change (r = 0.14, p = 0.488). There was no correlation (r = 0.10, p = 0.603) or association (chi-square test, p = 0.211) between aortic diameter change at the level of the SMA and the infrarenal neck. CONCLUSIONS: This investigation shows a significant dilatation of the infrarenal aneurysm neck, but not in the suprarenal aorta, after endovascular AAA repair with this device. The clinical significance of these findings is unclear. Whether such a dilatation in the infrarenal aneurysm neck may affect the long-term attachment of stent-grafts remains to be shown in the future.
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