Treatment of Type II Endoleak and Aneurysm Expansion after EVAR
| Autor: | Elias Brountzos, Constantine N. Antonopoulos, Spyridon N. Vasdekis, George Mantas, Andreas M. Lazaris, Konstantinos G. Moulakakis, John D. Kakisis, George S. Sfyroeras, Christos Klonaris, George Geroulakos |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Time Factors Aortography Databases Factual Endoleak Computed Tomography Angiography medicine.medical_treatment 030204 cardiovascular system & hematology Endovascular aneurysm repair Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm 0302 clinical medicine Hematoma Aneurysm Risk Factors Laparotomy medicine Humans Embolization Ligation Aged Retrospective Studies Computed tomography angiography Aged 80 and over Greece medicine.diagnostic_test business.industry Endovascular Procedures Suture Techniques General Medicine medicine.disease Embolization Therapeutic Surgery Treatment Outcome Female Radiology Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Aortic Aneurysm Abdominal |
| Zdroj: | Annals of Vascular Surgery. 39:56-66 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2016.08.029 |
| Popis: | Background The management of type II endoleak causing sac enlargement continues to be a topic of debate. The purpose of this study was to examine and compare the outcomes between open surgical technique with sacotomy and suturing of the feeding vessels to interventional embolization in patients with aneurysm sac expansion after endovascular aneurysm repair (EVAR). Methods Inclusion criteria for intervention in patients with prior EVAR and type II endoleak were asymptomatic expanding aneurysm sac > 5 mm between 2 consecutive follow-up computed tomography angiography scans and symptomatic aneurysm sac expansion. Age, sex, comorbidities, clinical presentation, commercial type of endograft of prior EVAR, aneurysm sac increase, type of treatment, morbidity, mortality, and follow-up were also recorded. Results A total of 694 consecutive patients were operated with EVAR during the study period. Among them, 29 patients (4.2%) were presented with a type II endoleak that required reintervention. Ten patients (34.5%) were treated with embolization. We recorded a 50% technical success in the group of primary translumbar embolization and 67% in the group of intra-arterial embolization. Twenty-two patients were treated with laparotomy and open ligation of the culprit arteries causing the type II endoleak. Among them, 3 patients (13.6%) had been initially treated with unsuccessful embolization. Periprocedural intervention complications for the embolization group (10%, 1/10) included 1 psoas hematoma. On the contrary, complications after primary open ligation were 13.6% (3/22) and included 1 proximal dislocation treated with endograft explantation, 1 distal dislocation, and 1 limb ligation with femoral-femoral bypass which resulted in colonic ischemia and death (4.5%). Conclusions Open surgical repair with sacotomy and suturing of the feeding vessels appeared to have better outcome regarding the exclusion of the aneurysm but was associated with a higher incidence of severe complications and one related death. If these results are confirmed in larger series, endovascular approach should be the preferred treatment option. |
| Databáze: | OpenAIRE |
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