| 1. |
- Alhadad, Alaa, et al.
(författare)
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Predictors of long-term beneficial effects on blood pressure after percutaneous transluminal renal angioplasty in atherosclerotic renal artery stenosis.
- 2009
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Ingår i: International Angiology. - 1827-1839. ; 28:2, s. 106-112
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This retrospective study evaluated long-term effects of percutaneous transluminal renal angioplasty (PTRA) in atherosclerotic renal artery stenosis (ARAS), and predictors of benefit on blood pressure (BP). METHODS: During 1997-2003, 234 patients (age 69+/-11 years, 138 [59%] males) underwent PTRA for ARAS at Malmö Vascular Centre. Cure was defined as diastolic (D)BP<90 mmHg and systolic (S)BP <140 mmHg off antihypertensive medication. Improvement was defined as DBP <90 mmHg and/or SBP <140 mmHg on the same or reduced number of medications, or reduction in DBP of 15 mmHg with the same or reduced number of medications. Benefit was defined as cure or improvement. RESULTS: After PTRA, SBP and DBP decreased (P<0.001), and remained lower (P<0.001) until last follow-up after 4.1+/-3.3 years. Antihypertensive medication decreased (P<0.001), and remained lower at one month (P<0.001), one year (P<0.01), and last follow-up (P<0.05). Renal function was unchanged until last follow-up, when it deteriorated (P<0.001). Patients showing benefit of PTRA on BP at last follow-up (N.=150 [64%]) used more antihypertensive drugs before PTRA (P=0.012), especially angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) (P=0.010), and diuretics (P=0.015). In logistic regression, use of ACEi or ARBs failed to reach significancy (P=0.054). Patients dying during follow up (N.=100 [43%]) showed higher age (P<0.0001) and s-creatinine (P<0.0001), lower glomerular filtration rate (P<0.0001), and higher frequency of diabetes mellitus (P<0.005). In logistic regression only age (P=0.009) and diabetes mellitus (P=0.014) predicted mortality. CONCLUSIONS: We confirmed beneficial effects on BP with PTRA in ARAS. ACEi, ARB and diuretic treatment before PTRA predict favourable long-term BP-response in univariate analysis.
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| 2. |
- Alhadad, Alaa, et al.
(författare)
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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis
- 2005
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Ingår i: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 19:10, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0 +/- 4.7 years (140 +/- 25/83 +/- 12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year ( from 84 +/- 28 to 75 +/- 13 mu mol/ l; P = 0.0030) and last follow-up (75 +/- 16 mu mol/ l; P = 0.0017). The number of antihypertensive drugs decreased ( from 2.3 +/- 1.2 before PTRA to 1.4 +/- 1.3 at discharge and at 1 month; P<0.0001, and 1.6 +/- 1.5 at last follow-up; P = 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43 +/- 29 vs 20 +/- 41 mmHg; P = 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9 +/- 7.7 vs 1.8 +/- 4.1 years; P = 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.
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| 3. |
- Björses, Katarina, et al.
(författare)
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Kissingstents in the Aortic Bifurcation - a Valid Reconstruction for Aorto-iliac Occlusive Disease.
- 2008
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Ingår i: European journal of vascular and endovascular surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; Aug 7, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate outcome and patency predicting factors of kissingstent treatment for aorto iliac occlusive disease (AIOD). METHODS: Patients treated with kissingstents for AOID between 1995 and 2004 at a tertiary referral center were identified through local databases. Chart review and preoperative images were used for TASC and Fontaine classification. Follow-up consisted of clinical exams, ABI and/or duplex. Patency rates were estimated by Kaplan-Meier analysis, and Cox multivariate regression was used to determine factors associated with patency. RESULTS: 173 consecutive patients (46% male, mean 64 years) were identified. TASC distribution was: A 15%, B 34%, C 10%, D 41%. Mean follow-up was 36 months (range: 1-144). 30-day mortality was 1% (2 patients), and 1-year survival was 91% (157 patients). 2 patients underwent late, open conversion and 13 patients suffered minor puncture site complications. Primary, assisted primary and secondary patency was: 97%, 99% and 100%, and 83%, 90% and 95% at twelve and 36 months respectively. There was no significant difference in patency between the TASC groups. Patency was significantly worse for patients in Fontaine class III. CONCLUSIONS: Aortoiliac kissing stents is a valid alternative to open repair for TASC A-D lesions. The procedure has low mortality and morbidity and good patency at 3 years.
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| 4. |
- 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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| 5. |
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| 6. |
- 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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| 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. |
- Dias, Nuno, et al.
(författare)
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Reply.
- 2008
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 47:4, s. 899-900
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
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| 11. |
- Hinchliffe, R, et al.
(författare)
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Endovascular Aneurysm Repair: Current and Future Status.
- 2008
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 0174-1551 .- 1432-086X. ; 31, s. 451-459
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 12. |
- Hinchliffe, R J, et al.
(författare)
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Observations on the Failure of Stent-Grafts in the Aortic Arch.
- 2007
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 34:4, s. 6-451
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Tidskriftsartikel (refereegranskat)abstract
- Abstract INTRODUCTION: The results of endovascular stent-grafts in the abdominal aorta and descending thoracic aorta have been encouraging. Expanding the use of thoracic stent-grafts in to the aortic arch has been associated with increasing numbers of complications. Recently isolated cases of stent-graft collapse have been reported. METHODS: This was a multi-centre European case series. Data was collected retrospectively on seven patients from five experienced endovascular centres with thoracic stent-graft collapse. RESULTS: Of the seven patients four were treated for traumatic aortic rupture. Six were male, median age 33 (range 17-54) years. During the ensuing 2 months all patients suffered stent-graft collapse. This was symptomatic in 3 patients and the rest were identified on CT. Endovascular management was possible in 6/7 patients using either a balloon expandable stent (n=6) or further stent-graft (n=1). Two patients had persistent type I endoleak despite treatment. Two of the 7 patients died, both of which presented with symptomatic thoracic stent-graft occlusion. Both deaths were a direct result of stent-graft collapse. CONCLUSIONS: Thoracic stent-graft collapse may be asymptomatic underscoring the importance of stent-graft surveillance. Endovascular management of collapse is possible in most cases using a large balloon expandable stent. Symptomatic collapse is associated with high morbidity and mortality.
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| 13. |
- Hinchliffe, Robert J., et al.
(författare)
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"Paving and cracking": An endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries
- 2007
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Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 14:5, s. 630-633
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries. Technique: The technique involves relining and dilating ("paving and cracking") stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed. Conclusion: This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.
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| 14. |
- 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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| 15. |
- Ivancev, Krassi, et al.
(författare)
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Novel access technique facilitating carotid artery stenting
- 2006
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Ingår i: Vascular. - : SAGE Publications. - 1708-539X .- 1708-5381. ; 14:4, s. 219-222
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Tidskriftsartikel (refereegranskat)abstract
- Carotid artery stenting (CAS) may be impossible, or associated with a high risk, in patients with severe vessel tortuosity. A novel method of catheterization of the carotid artery intended to facilitate CAS is described. It involves the placement of a microcatheter and a coronary wire through a dissected superficial temporal artery (STA), and then advanced to the ascending aorta. The wire is then snared and brought out through a sheath already placed from the common femoral artery (CFA). Thus through-and-through access from the STA to the CFA is established. The sheath is then brought over the coronary artery into the common carotid artery. Using the coronary artery as "buddy wire" the carotid artery stenting is carried out in a standard fashion. The potential benefit of this new technique is the decrease of risk of the procedures in patients with prohibiting vessel tortuosity.
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| 16. |
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| 17. |
- Kölbel, Tilo, et al.
(författare)
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Chronic iliac vein occlusion: midterm results of endovascular recanalization.
- 2009
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Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:4, s. 483-491
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:To evaluate patency and clinical outcome in patients treated with endovascular recanalization and stent placement for chronic iliac vein occlusions. METHODS:During a 14-year period (1994-2008), 59 (38 women; median age 39 years) of 62 patients with chronic occlusion of the iliac vein segment in 66 limbs were successfully treated with endovascular recanalization and stent placement. A prospectively maintained database was analyzed retrospectively to obtain information on clinical details, endovascular techniques, and outcome. RESULTS:Three (5%) procedures failed for technical reasons. Three (5%) complications occurred, 2 (3%) of which were perforations requiring transfusion and procedure termination. Initial clinical success after 6 months was achieved in 49 (83%) of the 59 patients successfully treated initially. Primary patency after a median imaging follow-up of 25 months was 67% (44/66), assisted primary patency was 75% (49/66), and secondary patency was 79% (52/66). Fifteen (23%) of 66 limbs were asymptomatic after a median clinical follow-up of 32 months, 34 (52%) limbs were improved, 13 (20%) were unchanged, and 4 (6%) were worse compared to before intervention. Actuarial primary, assisted primary, and secondary patency rates using Kaplan-Meier survival analysis were 70%, 73%, and 80%, respectively, at 5 years. CONCLUSION:Endovascular recanalization and stent placement is a safe and effective treatment for occluded iliac veins and adjacent segments. Clinical midterm results are encouraging. Recanalized and stented segments remain patent in the majority of patients after 2 years. Endovascular treatment can ease symptoms and prevent further deterioration of patients with post-thrombotic syndrome.
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| 18. |
- Kölbel, Tilo, et al.
(författare)
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Endovascular treatment of venous occlusive disease
- 2009
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Ingår i: Gefässchirurgie. - : Springer Science and Business Media LLC. - 1434-3932 .- 0948-7034. ; 14:4, s. 292-292
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Forskningsöversikt (refereegranskat)abstract
- In the past, open surgical techniques such as thrombectomy and bypasses were the treatments of choice for acute and chronic venous occlusive disease of the iliocaval vein segments, but the results were often disappointing. With the introduction of endovascular techniques in the 1990s, open techniques were widely replaced by endovascular interventions. Proper preoperative imaging with computed tomography and magnetic resonance phlebography has become an important part of procedure planning, but phlebography by direct puncture with contrast injection in the immediate proximity of the iliofemoral segment is still the most informative diagnostic method. Catheter-directed thrombolysis with recanalization and stenting of underlying chronic obstructions is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as conservative treatment is not satisfactory for preventing postthrombotic syndrome. Recanalization of chronic iliac vein occlusions with balloon angioplasty and stenting can reestablish normal venous flow in the iliac veins and inferior vena cava and relieve symptoms in the majority of treated patients. New treatment modalities offer stimulating options for patients not treated adequately either by medical or open surgical therapy.
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| 19. |
- Kölbel, Tilo, et al.
(författare)
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In situ bending of a thoracic stent-graft: A proposed novel technique to improve thoracic endograft seal
- 2008
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Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 15:1, s. 62-66
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To demonstrate the feasibility of a novel technique that modifies the configuration of a thoracic stent-graft after deployment to comply with the arch curvature. Technique: The principle of a Bowden cable has been applied to direct a conventional thoracic stent-graft in situ after deployment. A suture placed at the proximal inner curve of a conventional thoracic stent-graft is fitted with a sliding, self-locking knot attached to a line that runs inside a catheter through the central rod of the stent-graft. Traction applied to this line directs the endograft post deployment, which allows for better apposition to the aortic wall. Shortening the inner curve makes the stent-graft bend. The extent of bending is fully controlled by the surgeon and held in place with the sliding knot. A release mechanism allows removal of all luminal components of the mechanism. Conclusion: The described technique of directing a thoracic stent-graft in situ seems feasible and enables better apposition of the stent-graft in a glass model. It may improve the durability of thoracic stent-grafts in the aortic arch.
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| 20. |
- Lindblad, Bengt, et al.
(författare)
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Novel Technique for Treatment of a Renal Artery Occlusion in a Child With Neurofibromatosis: A Combined Endovascular and Laparoscopic Approach
- 2009
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Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 43:2, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- Neurofibromatosis is associated with mid-aortic dysplasia, renal artery aneurysms and renal artery ostial stenosis, or occlusions in about 1% of cases. We describe a novel approach to recanalize an occluded renal artery in a 10-year-old girl with neurofibromatosis and difficulty in pharmacologically controlling her hypertension. Normally, when reconstruction is required, an open operative technique is used. We report on the combined use of laparoscopic exposure and percutaneous retrograde puncture of the occluded renal artery, which could be recanalized and stented. The pros and cons of this new approach are discussed.
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| 21. |
- Lindblad, Bengt, et al.
(författare)
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What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae.
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:2, s. 165-173
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Tidskriftsartikel (refereegranskat)abstract
- Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available. MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment. RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended. CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
- Malina, Martin, et al.
(författare)
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Feasibility of a branched stent-graft in common iliac artery aneurysms.
- 2006
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Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 13:4, s. 496-500
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the short-term feasibility, efficacy, and safety of a modular bifurcated stent-graft with an internal iliac artery (IIA) side branch for endovascular repair of aortoiliac aneurysms. Methods: Between 2002 and 2005, 10 male patients (median age 75 years, range 59–83) were treated with a bifurcated stent-graft that included a unilateral side branch for the IIA. The median diameters of the abdominal aortic and common iliac artery (CIA) aneurysms were 56 mm (range 33–80) and 40 mm (range 27–60), respectively. Four patients were treated mainly for the CIA aneurysm. Postoperative endoleaks, patency rate, and vessel morphology were determined with contrast-enhanced computed tomography (CT). Results: All endografts were implanted in the desired position. One IIA occluded intraoperatively, and 1 external iliac artery occlusion was noted 6 months postoperatively; both occlusions were asymptomatic and remain untreated. Three graft-related endoleaks were treated with implantation of adjunctive stent-grafts (2 intraoperative and 1 late). Median follow-up by CT was 2 months (1 week to 32 months). One patient died of myocardial infarction 13 days postoperatively; the stent-graft was patent at autopsy. Conclusion: Stent-grafts with an IIA side branch offer an opportunity to repair aortoiliac aneurysms without sacrificing the IIA. Implantation of the IIA branch is more complex than routine endovascular aneurysm repair and may have contributed to a periprocedural cardiac death. More patients and longer follow-up are needed to verify these data.
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