Endovascular stent-graft repair of failed endovascular abdominal aortic aneurysm repair

被引:25
作者
Baril, Donald T. [1 ]
Silverberg, Daniel [1 ]
Ellozy, Sharif H. [1 ]
Carroccio, Alflo [1 ]
Jacobs, Tikva S. [1 ]
Sachdev, Ulka [1 ]
Teodorescu, Victoria J. [1 ]
Lookstein, Robert A. [1 ]
Marin, Michael L. [1 ]
机构
[1] Mt Sinai Sch Med, Dept Surg, Div Vasc Surg, New York, NY 10029 USA
关键词
D O I
10.1016/j.avsg.2007.10.003
中图分类号
R61 [外科手术学];
学科分类号
摘要
Despite high initial technical success, the long-term durability of endovascular abdominal aortic aneurysm repair (EVAR) continues to be a concern. Following EVAR, patients can experience endoleaks, device migration, device fractures, or aneurysm growth that may require intervention. The purpose of this study was to review all patients treated with secondary enclovascular devices at our institution for failed EVAR procedures. Over an 8-year period, 988 patients underwent EVAR, of whom 42 (4.3%) required secondary interventions involving placement of additional enclovascular devices. Data regarding patient characteristics, aneurysm size, initial device type, time until failure, failure etiology, secondary interventions, and outcomes were reviewed. The mean time from initial operation until second operation was 34.1 months. Failures included type I endoleaks in 38 patients (90.5%), type III endoleaks in two patients (4.8%), and enlarging aneurysms without definite encloleaks in two patients (4.8%). The overall technical success rate for secondary repair was 92.9% (39/42). Perioperative complications occurred in nine patients (21.4%), including wound complications (n = 6), cerebrovascular accident (CVA) (n = 1), foot drop (n = 1), and death (n = 1). Mean follow-up following secondary repair was 16.4 months (range 1-50). Eighty-six percent of patients treated with aorlouni-iliac devices had successful repairs compared to 45% of patients treated with proximal cuffs. Ten patients (23.8%) had persistent or recurrent type I or type III encloleaks following revision. Of these, four had tertiary interventions, including two patients who had additional devices placed. Failures following EVAR occur in a small but significant number of patients. When anatomically possible, enclovascular revision offers a safe means of treating these failures. Aortouni-iliac devices appear to offer a more durable repair than the proximal cuff for treatment of proximal type I endoleaks. Midterm results indicate that these patients may require additional procedures but have a low rate of aneurysm-related mortality. Longer-term follow-up is necessary to determine the durability of these enclovascular revisions.
引用
收藏
页码:30 / 36
页数:7
相关论文
共 29 条
[1]  
Alric P, 2002, J ENDOVASC THER, V9, P719, DOI 10.1583/1545-1550(2002)009<0719:TZASGA>2.0.CO
[2]  
2
[3]   Aortic neck attachment failure and the AneuRx graft: Incidence, treatment options, and early results [J].
Azizzadeh, A ;
Sanchez, LA ;
Rubin, BG ;
Parodi, JC ;
Godshall, CJ ;
Geraghty, PJ ;
Choi, ET ;
Flye, MW ;
Curci, JA ;
Sicard, GA .
ANNALS OF VASCULAR SURGERY, 2005, 19 (04) :516-521
[4]   Open versus endovascular abdominal aortic aneurysm repair in VA hospitals [J].
Bush, RL ;
Johnson, ML ;
Collins, TC ;
Henderson, WG ;
Khuri, SF ;
Yu, HJ ;
Lin, PH ;
Lumsden, AB ;
Ashton, CM .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2006, 202 (04) :577-587
[5]   Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts [J].
Cao, P ;
Verzini, F ;
Parlani, G ;
De Rango, P ;
Parente, B ;
Giordano, G ;
Mosca, S ;
Maselli, A .
JOURNAL OF VASCULAR SURGERY, 2003, 37 (06) :1200-1205
[6]   Mid-term results after endovascular repair of abdominal aortic aneurysms: A four-year experience [J].
Dalainas, I ;
Nano, G ;
Casana, R ;
Tealdi, DG .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2004, 27 (03) :319-323
[7]   Midterm pivotal trial results of the Talent Low Profile System for repair of abdominal aortic aneurysm: Analysis of complicated versus uncomplicated aortic necks [J].
Fairman, RM ;
Velazquez, OC ;
Carpenter, JP ;
Woo, E ;
Baum, RA ;
Golden, MA ;
Kritpracha, B ;
Criado, F .
JOURNAL OF VASCULAR SURGERY, 2004, 40 (06) :1074-1082
[8]   Management of endoleak after endovascular aneurysm repair: Cuffs, coils, and conversion [J].
Faries, PL ;
Cadot, H ;
Agarwal, G ;
Kent, C ;
Hollier, LH ;
Marin, ML .
JOURNAL OF VASCULAR SURGERY, 2003, 37 (06) :1155-1161
[9]   Failure of endovascular aortoaortic tube grafts: A plea for preferential use of bifurcated grafts [J].
Faries, PL ;
Briggs, VL ;
Rhee, JY ;
Burks, JA ;
Gravereaux, EC ;
Carroccio, A ;
Morrissey, NJ ;
Teodorescu, V ;
Hollier, LH ;
Marin, ML .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (05) :868-873
[10]   Zenith AAA endovascular graft: Intermediateterm results of the US multicenter trial [J].
Greenberg, RK ;
Chuter, TAM ;
Sternbergh, C ;
Fearnot, NE .
JOURNAL OF VASCULAR SURGERY, 2004, 39 (06) :1209-1218