Preservation of Stent Graft after Iatrogenic Type III Endoleak during Open Transperitoneal Surgical Intervention for Complicated Type II Endoleak
| Autor: | Jack Kian Ch'ng, Chng Siew Ping, Ken Min Chin, Han Jie Lee, Shaun Q.W. Lee |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Endoleak medicine.medical_treatment Iatrogenic Disease 030204 cardiovascular system & hematology Prosthesis Design 030218 nuclear medicine & medical imaging Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm 0302 clinical medicine Blood vessel prosthesis medicine.artery Humans Medicine Aged 80 and over Surgical approach Modalities business.industry Endovascular Procedures Stent General Medicine medicine.disease Blood Vessel Prosthesis Surgery Treatment Outcome Stents Cardiology and Cardiovascular Medicine business Complication Lumbar arteries Aortic Aneurysm Abdominal Abdominal surgery |
| Zdroj: | Annals of Vascular Surgery. 62:496.e1-496.e7 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2019.06.002 |
| Popis: | Background The use of an endovascular approach for treatment of abdominal aortic aneurysms has gained traction over the past 2 decades. One of the major drawbacks of the endovascular approach is the increased rates of reintervention, with the majority arising from endoleaks that occur up to 20% of the time. Although type II endoleak is the most common subtype (25–45% of all endoleaks), it is associated with the greatest dilemma and debate with regard to indications and modalities of treatment. The open surgical approach to management of type II endoleak has gained interest and popularity over the years because of issues associated with the endovascular approach. Methods We present a case of a patient with type II endoleak undergoing transperitoneal sacotomy, endoaneurysmorrhaphy, and stent-graft preservation, after having failed endovascular intervention. In addition, we describe the difficulties associated with posteriorly located backbleeding lumbar arteries and a unique case of iatrogenically created type III endoleak intraoperatively. Results A literature review was performed with regard to the risk factors, indications for intervention, and modalities of treatment for type II endoleaks. In addition, suggestions are provided for future improvements in surgical technique. Conclusions Type II endoleak is a common complication of endovascular aortic repair. In spite of this, management strategies are poorly standardized with no definitive gold standard. More collective data and pooled experience will be needed to further refine the open surgical technique and objectively assess its benefits and shortcomings vis-a-vis other alternatives. |
| Databáze: | OpenAIRE |
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