Type IIIb endoleak after elective endovascular aneurysm repair: a systematic review
| Autor: | Manmohan Madan, Christopher Lowe, Vivak Hansrani, George A. Antoniou |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Time Factors Endoleak medicine.medical_treatment 030204 cardiovascular system & hematology Endovascular aneurysm repair Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm 0302 clinical medicine Aneurysm Risk Factors medicine Humans Aged Aged 80 and over Type iiib business.industry Mortality rate Endovascular Procedures General Medicine Middle Aged medicine.disease Surgery Treatment Outcome 030228 respiratory system Elective Surgical Procedures Etiology Female Cardiology and Cardiovascular Medicine Elective Surgical Procedure business Aortic Aneurysm Abdominal Abdominal surgery |
| Zdroj: | The Journal of Cardiovascular Surgery. 61 |
| ISSN: | 1827-191X 0021-9509 |
| Popis: | Introduction The aim of this article is to investigate the presentation, etiology, management and outcomes of type IIIb endoleak after endovascular aneurysm repair (EVAR). Evidence acquisition Electronic bibliographic databases were searched to identify published reports of type IIIb endoleak after EVAR, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence synthesis In total 33 articles were identified reporting on a total of 50 patients spanning 19 years of EVAR (1998-2017). Some 11 device-types were used. The median time from implantation to intervention was 27 months (0-168). There was a significant aneurysm sac expansion in 69% of reported cases. Thirteen patients (26%) presented with aneurysm rupture. A definitive diagnosis of type IIIb endoleak made on computed tomographic angiography (CTA) in only 20% of cases. Proposed failure modes included suture breakage, graft erosion by stents, iatrogenic, graft infection and presumed manufacturing faults. Endoleak location was in the main body in 81% of reported cases. Almost one third (31%) of patients were treated with open repair. The remaining patients were treated with endovascular techniques or hybrid procedures. Some novel off-label endovascular solutions were proposed to maintain a bifurcated configuration. Thirty-day mortality in patients treated for aneurysm rupture was 50%. The 30-day mortality rate in non- rupture cases was 2% (endovascular 0% treatment, open 2%). Conclusions Type IIIb endoleak is a serious condition associated with a significant risk of rupture. Definitive diagnosis is challenging and has been described in almost all conventional devices. Most patients can be treated successfully by endovascular means, though maintaining a bifurcated configuration may require non-standard techniques or off-label use. |
| Databáze: | OpenAIRE |
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