Abdominal Aortic Aneurysm Wall Stresses After Endovascular Repair

Author(s):  
Elena S. Di Martino ◽  
Michel S. Makaroun ◽  
David A. Vorp

The early benefits of an endovascular approach to abdominal aortic aneurysm (AAA) treatment has been reported by many authors [1,2]. One of the major advantages is that endovascular repair of AAA (EVAR) as opposed to traditional open surgery, is not a major abdominal surgery. EVAR has been shown to be associated with a death rate comparable to that of surgical repair [3]. In short term follow-up, EVAR is associated with fewer complications and a more rapid recovery [2]. On the contrary very limited data is available on long term follow-up of EVAR patients. Graft-related secondary interventions affect a consistent percentage of the treated cases. The EUROSTAR study [4] recently reported 13% of reintervention in 15.4 months. Our surgical unit reported 20.6% across 48 months in a recent review of 242 cases [3]. The frequence and type of reintervention, whose principal cause is endoleak or perigraft flow, requires careful consideration.

2010 ◽  
Vol 24 (8) ◽  
pp. 1053-1059 ◽  
Author(s):  
Gioacchino Coppi ◽  
Francesco Rametta ◽  
Stefano Aiello ◽  
Giuseppe Saitta ◽  
Stefano Gennai ◽  
...  

Angiology ◽  
2020 ◽  
Vol 71 (7) ◽  
pp. 641-649
Author(s):  
Rebecka Hultgren ◽  
K. Miriam Elfström ◽  
Daniel Öhman ◽  
Anneli Linné

A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.


2014 ◽  
Vol 2 ◽  
pp. 273-282 ◽  
Author(s):  
Gabriele Piffaretti ◽  
Giovanni Mariscalco ◽  
Francesca Riva ◽  
Federico Fontana ◽  
Gianpaolo Carrafiello ◽  
...  

2013 ◽  
Vol 27 (2) ◽  
pp. 241.e1-241.e5 ◽  
Author(s):  
Yvain Goudard ◽  
Charles Pierret ◽  
Bruno de La Villéon ◽  
Amélie Mlynski ◽  
Xavier de Kerangal

2013 ◽  
Vol 8 (1) ◽  
pp. 57 ◽  
Author(s):  
Regula S von Allmen ◽  
Florian Dick ◽  
Thomas R Wyss ◽  
Roger M Greenhalgh ◽  
◽  
...  

Endografts for repair of abdominal aortic aneurysm were first reported in the late 1980s and commercially available grafts were developed rapidly during the 1990s. This prompted a head-to-head comparison of the new, less invasive, endovascular technology with the existing gold standard of open repair. The first and largest randomised trial of open versus endovascular repair for large aneurysms started in the UK in 1999. Other trials comparing open and endovascular repair followed in the Netherlands, France and the US. Only the UK trial has reported long-term follow-up to 10 years. This has shown no statistically significant difference in long-term survival after open or endovascular repair. Aneurysm-related mortality curves converged at six years, which is described as endovascular aortic repair (EVAR) ‘catch up’ on open repair. It appears that this convergence is probably largely attributable to secondary sac rupture after endovascular repair, which is fatal in about two-thirds of cases. At this point, we have reached a crossroads and only longer-term follow-up data can provide the vital answer to the outcome of endovascular repair in the long run. This article gives a brief overview of the development and the current evidence of endovascular aortic repair and discusses the most important factors that are leading the way to the future of this technology.


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