scholarly journals Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery Vascular Quality Initiative

2016 ◽  
Vol 64 (2) ◽  
pp. 338-347 ◽  
Author(s):  
Salvatore T. Scali ◽  
Sara J. Runge ◽  
Robert J. Feezor ◽  
Kristina A. Giles ◽  
Javairiah Fatima ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Repair ◽  
Aneurysm Repair

scholarly journals Assessing the institutional learning curve for pararenal aortic repair using the fenestrated Anaconda endograft

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Fadi Taher ◽  
Juergen Falkensammer ◽  
Joseph Nguyen ◽  
Miriam Uhlmann ◽  
Edda Skrinjar ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endovascular Aneurysm Repair ◽  
Mortality Rates ◽  
Lower Percentage ◽  
Technical Success ◽  
Dose Area Product ◽  
Aortic Repair ◽  
Area Product ◽  
Aneurysm Repair ◽  
Over Time

Objective Custom-made fenestrated aortic endografts allow exclusion of pararenal aortic aneurysms while maintaining blood flow to aortic branches. Meticulous device planning and precise deployment of the main body are essential to allow successful cannulation of the fenestrations. This study investigates whether a learning curve can be observed with more reliable cannulation and connection of fenestrations over time at a single department of vascular and endovascular surgery with multiple surgeons trained to use the device. Methods A retrospective analysis of data from all patients undergoing primary fenestrated endovascular aneurysm repair during the study period was performed. Outcome measures included case volume and average number of fenestrations over time, average fluoroscopy dose area product per calendar year and primary unconnected fenestration and 30-day mortality rates. Results Between 1 January 2013 and 31 December 2016, 89 patients with no history of endovascular aneurysm repair underwent fenestrated endovascular aneurysm repair at our institution. The number of fenestrations per case increased over time, averaging 2.6 in 2013 and 3.3 in 2016. Primary unconnected fenestration and 30-day mortality rates were 5.6%. Primary-assisted technical success was 93.3%, secondary-assisted technical success was 94.4%. Fluoroscopy dose area product declined over the study period. Thirty-day mortality and primary unconnected fenestration rates did not significantly change over the study period. Conclusion Albeit the reduction in lethal complications and primary technical success rates were not statistically significant, a lower percentage of unconnected fenestrations and 30-day mortality per calendar year were observed over time. At the same time, an increasing complexity of performed cases, as reflected by an increasing number of fenestrations per case, was observed. Complications associated with this complex endovascular procedure are potentially lethal and remain an unfortunate reality and may not be entirely dependent on overcoming a learning curve. A higher volume of cases performed over the study period and a reduction in fluoroscopy use can be considered a representation of the institutional development and learning curve for the Anaconda fenestrated endograft at a department with prior complex endovascular aortic repair experience, but due to limitations of the current retrospective observation, deserve further consideration in future trials, ideally designed in a prospective fashion.

scholarly journals Successful Surgical Abdominal Aortic Debranching Preceding Stent Graft Implantation: A Case Report

2018 ◽  
Vol 07 (01) ◽  
pp. e24-e26
Author(s):  
Magdalena Laux ◽  
Michael Erb ◽  
Frank Hoelschermann ◽  
Johannes Albes
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Celiac Trunk ◽  
Safe Alternative ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Open Aortic Repair ◽  
Vein Bypass ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair

Background Acute endovascular aneurysm repair with stent grafts (thoracic endovascular aortic repair [TEVAR]) is safe and feasible. Case Description A 64-year-old female presented with a perforated aortic aneurysm of the thoracic descending aorta. Primary TEVAR resulted in good management of the perforation but a type Ib endoleakage remained postoperatively. To place another stent, abdominal debranching with saphenous vein bypass to the celiac trunk was required. In the same session, another endograft was inserted successfully. Conclusion Abdominal debranching is a safe alternative to open aortic repair in acute thoracic and abdominal aneurysms, instead of waiting for a custom-made device.

scholarly journals Future of Vascular Surgical Training: The Trainees' Views

2008 ◽  
Vol 90 (2) ◽  
pp. 96-99 ◽  
Author(s):  
Toby Richards ◽  
Keith Jones
Keyword(s):  
Vascular Surgery ◽  
Surgical Training ◽  
General Surgery ◽  
Endovascular Aneurysm Repair ◽  
Endovascular Techniques ◽  
European Working ◽  
The Uk ◽  
Aneurysm Repair ◽  
Working Time Directive ◽  
Future Work

INTRODUCTION In the UK, surgical training includes all aspects of general surgery. Vascular surgery is not an independent specialty. We wished to assess the views of vascular trainees in UK on the future of vascular surgery and training. MATERIALS AND METHODS Trainees were surveyed in 2003, 2004 (after introduction of the European Working Time Directive) and 2005, concentrating on four areas – future practise of vascular surgery, role of endovascular training, vascular specialisation and future training. RESULTS The majority of trainees want to practise vascular surgery alone. In 2003, 80% thought training should include endovascular techniques. By 2005, all trainees regarded training as mandatory as endovascular techniques would represent a significant part of their future work. Opinion changed on training; from 4 years general then 2 years vascular surgery (qualification in general surgery) to 2 years general and 4 years vascular surgery (specialist qualification in vascular surgery; P < 0.0001). Opinion also changed, that vascular surgery should spilt from general surgery to form its own speciality (P < 0.0007). CONCLUSIONS Trainees now regard training in endovascular techniques and endovascular aneurysm repair as mandatory. The majority wish to specialise from general surgery and achieve a separate qualification in vascular surgery.

scholarly journals Salvage endovascular septectomy in patients with chronic abdominal aortic dissection after failed endovascular aneurysm repair

2019 ◽  
Vol 29 (4) ◽  
pp. 621-624
Author(s):  
Hui Zhuang ◽  
Fanggang Cai ◽  
Zhixian Wu ◽  
Tenghui Zhan ◽  
Hongyu Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Endovascular Aneurysm Repair ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Study Cohort ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aneurysm Repair

Abstract This study aimed to investigate the efficacy and safety of salvage endovascular septectomy in patients with abdominal chronic aortic dissection (CAD) after endovascular aneurysm repair. A study cohort comprising 6 patients with chronic abdominal aortic dissection after failed endovascular aortic repair [mean age 62.5 (36–69) years] were enrolled to undergo salvage endovascular septectomy. The procedure involved entering the false lumen via the intrinsic visceral entry to perform a confined septectomy using a ‘Gigli wire’ to merge the true and false lumens. The outcomes were assessed by Digital angiography and computed tomography angiography. All 6 patients were successfully operated on; the diameters of the visceral abdominal aorta and the infrarenal abdominal aorta were similar at 1, 3, 6 and 12 months compared with the baseline; the patency of the visceral branch arteries was also stable at 1, 3, 6 and 12 months compared with the baseline; no occlusion of the visceral branch arteries was noted; no major vascular adverse events or deaths were observed. In this preliminary study, it was proven that salvage endovascular septectomy is a potentially advantageous technique that is safe and effective in the treatment of patients with CAD after failed endovascular aortic repair.

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