scholarly journals Abdominal Aortic Disease: A Multicase Review

2019 ◽  
Vol 43 (1) ◽  
pp. 18-24
Author(s):  
Joshua D. Lee ◽  
Courtney Webb ◽  
Mark W. Fugate
Keyword(s):  
Patient Care ◽  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Artery Aneurysm ◽  
Disease Diagnosis ◽  
Aortic Disease ◽  
Type I ◽  
Abdominal Aortic ◽  
Type I Endoleak ◽  
Vascular Laboratory

Abdominal aortic disease affects more than 3 million people per year. For vascular sonographers, imaging aortic disease can become routine. Therefore, it is necessary to expand the knowledge that we have of aortic disease, diagnosis, and treatment. We present 4 cases with new or worsening conditions diagnosed by duplex ultrasound (DUS). Our first case is a 79-year-old woman returning for surveillance of an endovascular aneurysm repair (EVAR). The DUS findings reveal an increasing abdominal aortic aneurysm (AAA) sac, with evidence of flow originating from an incomplete seal at the attachment suggesting type I endoleak. Next, is a 56-year-old man returning 1 month after type A dissection repair, now presenting with unilateral claudication. The DUS findings of the left lower extremity demonstrated an early systolic deceleration waveform, suggesting more proximal disease. Upon further imaging, an abdominal aortic dissection was identified terminating into the left internal iliac artery, causing the true lumen to be compressed. The third case was a 75-year-old man returning for follow-up of an EVAR and iliac repair. The DUS findings show an increase in iliac artery sac size and anechoic area that was filled with color Doppler flow. These findings are suggestive of type I endoleak involving the distal attachment. The last case is a 56-year-old man returning for EVAR and iliac artery repair surveillance. The common iliac artery aneurysm sac had increased in diameter and length. The distal attachment of the left iliac extension cuff terminated within the aneurysm sac, causing a type I endoleak. Accurate DUS diagnosis of aortic disease is crucial for patient care. Meticulous analysis of the vessels and surrounding structures can make a difference in diagnostic outcomes. Vascular sonographers should continually review and revise vascular laboratory protocols to increase their diagnostic accuracy and improve patient care. It is important to extend the vascular laboratory protocols when complex cases arise to better demonstrate complicated diagnoses and challenging anatomy.

Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 828-835
Author(s):  
Shota Ohba ◽  
Masashi Shimohira ◽  
Takuya Hashizume ◽  
Masahiro Muto ◽  
Kengo Ohta ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Artery Aneurysm ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Success Rates ◽  
Iliac Artery Aneurysm ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. Materials and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). Conclusion: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

Single-stage thoracic and abdominal endovascular aneurysm repair for multilevel aortic disease

Vascular ◽  
2013 ◽  
Vol 22 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Makoto Samura ◽  
Nobuya Zempo ◽  
Yoshitaka Ikeda ◽  
Masaaki Hidaka ◽  
Yoshikazu Kaneda ◽  
...  
Keyword(s):  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Single Stage ◽  
Type I ◽  
Abdominal Aortic ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair

This investigation evaluated the results of single-stage thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR) for multilevel aortic disease in a series of nine patients. The lesions repaired included thoracic and abdominal aortic aneurysms ( n = 7) and subacute type B dissections with abdominal aortic aneurysms ( n = 2). All procedures were successfully performed, and none of the patients experienced postoperative stroke or spinal cord ischemia. The median follow-up period for these patients was 18.9 months (range 1.7–31.4 months) and none of the patients exhibited any signs of type I endoleaks or aneurysmal diameter enlargements more than 5 mm. In conclusion, single-stage TEVAR and EVAR procedures for multilevel aortic disease were found to be safe and feasible modalities for high-risk patients.

scholarly journals Endovascular Treatment of Common Iliac Artery Aneurysms With an Iliac Branch Device

2016 ◽  
Vol 24 (2) ◽  
pp. 239-245 ◽  
Author(s):  
Hidde Jongsma ◽  
Joost A. Bekken ◽  
Wouter J. J. Bekkers ◽  
Clark J. Zeebregts ◽  
Joost van Herwaarden ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Type I ◽  
Secondary Interventions ◽  
Abdominal Aortic ◽  
Internal Iliac ◽  
Antegrade Flow ◽  
Aneurysm Repair

Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.

scholarly journals Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Robert A. Morgan ◽  
Ian Loftus ◽  
Lakshmi Ratnam ◽  
Raj Das ◽  
Leto Mailli ◽  
...  
Keyword(s):  
Shape Memory ◽  
Clinical Experience ◽  
Iliac Artery ◽  
Shape Memory Polymer ◽  
Endovascular Aneurysm Repair ◽  
Case Series ◽  
Artery Aneurysm ◽  
Gelatin Sponge ◽  
Peripheral Vasculature ◽  
Small Series

Abstract Background Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. Results Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5–10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45–90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. Conclusions This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arteries and further experience will demonstrate the utility of the shape memory polymer devices.

Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimer Assay to Detect Type I Endoleaks and Nonshrinking Aneurysms

2002 ◽  
Vol 9 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Francesco Serino ◽  
Damiano Abeni ◽  
Elisabetta Galvagni ◽  
Savino G. Sardella ◽  
Alberto Scuro ◽  
...  
Keyword(s):  
Thrombotic Event ◽  
Endovascular Aneurysm Repair ◽  
Test Group ◽  
Type I ◽  
Type Ii ◽  
Type Ii Endoleak ◽  
Blood Samples ◽  
Type I Endoleak ◽  
D Values ◽  
D Dimer

Purpose: To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair. Methods: In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak. Results: Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 ± 180 ng/mL versus 421 ± 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 ± 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 ± 728 ng/mL) than in cases with decreasing diameters (median 638 ± 238 ng/mL) despite the presence of endoleak (p < 0.0005). Conclusions: Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.

scholarly journals Type I Endoleak Post-Endovascular Aneurysm Repair, Successfully Treated With Excluder Cuff and Fixation Screws

2018 ◽  
Vol 11 (1) ◽  
pp. e5-e6 ◽  
Author(s):  
Omar A. Ayah ◽  
Jordan Klein ◽  
Muhammad Raza ◽  
Daniel J. McCormick
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Type I ◽  
Type I Endoleak ◽  
Aneurysm Repair

scholarly journals Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

2014 ◽  
Vol 13 (4) ◽  
pp. 318-324
Author(s):  
Rodrigo Gibin Jaldin ◽  
Marcone Lima Sobreira ◽  
Regina Moura ◽  
Matheus Bertanha ◽  
Jamil Víctor de Oliveira Mariaúba ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Arterial Access ◽  
Abdominal Aortic ◽  
First Choice ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

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