Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy

Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.

Value of digital subtraction angiography in endovascular graft exclusion for abdominal aortic aneurysms

Objective: To evaluate the value of digital subtraction angiography (DSA) in management of endovascular graft exclusion (EVGE) for abdominal aortic aneurysms. Methods: Monitored by DSA and fluoroscopy, stent-graft complex were introduced into the aneurysm sac via femoral arteries and were deployed at the proximal and distal necks to exclude the sac from circulation. Results: The success rate of deployment was 94. 74% (36/38). Endoleaks occurred in 4 cases. One converted to open surgery because of sac rupture 4 days after deployment. Thrombosis and stenosis occurred in 2 cases. Three patients died shortly after the operation (< 3 months). Conclusion: DSA can monitor EVCE on real-time throughout the whole procedure. It can meet the needs of measurement, location, evaluating, detecting, and also can be much helpful in correcting complications. Moreover, it provides large visual field and operating space, and is a very important monitoring method for EVGE.

Standards of endovascular graft exclusion for abdominal aortic aneurysms

Objective: To discuss the standards of endovascular graft exclusion (EVGE) for abdominal aortic aneurysms (AAAs). Methods: The results of our primary experiences for the evidence of standards was summarized. Results: Standards of operating success, cure and procedure failure were put forward. Some relative questions on EVGE were also answered. Conclusion: EVGE is a kind of new conceptive therapy for AAAs in China. More cases should be evaluated in the future to modify it.

Endovascular Repair for Abdominal Aortic Aneurysm with an Ectopic Pelvic Kidney: Case Report and Procedural Consideration of the Aberrant Renal Artery

A 91-year-old female presented with a pulsatile abdominal mass. Her past medical history included hypertension and hyperlipidemia. A 6.9 cm infrarenal abdominal aortic aneurysm, with a left ectopic pelvic kidney and two aberrant renal arteries, one each from the left and right common iliac arteries was found on computed tomography. Because of the high risk of rupture, surgery was recommended and an endovascular aneurysm repair was performed. The antegrade flow of the aberrant renal artery from the left common iliac artery was preserved. The right aberrant renal artery was covered with stent graft. The patient’s serum creatinine level remained unchanged throughout the postoperative course, with an uneventful postoperative recovery.

Successful use of emergent endovascular aneurysm repair for a ruptured hypotensive abdominal aortic aneurysm

Ruptured aortic aneurysm has a surgical mortality ranging from 50%-70%, one of the highest rates of all vascular emergencies [1-5]. Less invasive approaches to repair have been developed that could potentially improve these statistics [1,5-7]. Endovascular aneurysm repair (EVAR) is a minimally invasive approach that may be an alternative to open surgical repair for select cases of ruptured aortic aneurysms [1,5]. Unfortunately, the role of EVAR in patients with acute rupture of an abdominal aneurysm is not clear, especially for patients that are hemodynamically unstable [1,8-10]. The literature is limited regarding use of EVAR in this population of patients. We present a case of the successful use of EVAR for an emergent repair in a hypotensive hemodynamically unstable patient with an acutely ruptured abdominal aortic aneurysm (AAA).

Endovascular Repair of Abdominal Aortic Aneurysm May Not Provide Long-Term Survival Benefit

Purpose: To investigate the long term survival benefit for the treatment of abdominal aortic aneurysmal (AAA) disease with Endovascular Aneurysm Repair (EVAR). Our hypothesis is that patients undergoing EVAR have an equivalent survival to an age matched population. Methods: Between 1997 and 2014 all patients treated for an AAA with EVAR by a single surgeon were prospectively followed and at 12 monthly intervals ultrasonography was utilised to assess the size of the aorta after treatment. Data from the Births, Deaths and Marriages was also collected regarding the survival of these patients. As of 2003 all patients with AAA were treated electively with EVAR. Results: There were a total of 145 patients treated with EVAR for AAA during the study period, 143 who survived the 30-day post-operative period. The long-term survival following EVAR at one year was 95% (95% C.I.: 88% to 97%), at 5 years 56% (95% C.I.: 42% to 64%), and at 10 years 28% (95% C.I.: 17% to 42%). Compared to an age-matched population the EVAR group had a lower than expected long term survival (P < 0.0001). Discussion: EVAR for the treatment of abdominal aortic aneurysms can be achieved with acceptable 30 day survival and freedom from aneurysm related death. However selection of patients for EVAR may significantly effect long-term survival if patients are fit for EVAR but not open operation. The question arises as to whether EVAR should be performed in patients with questionable long-term survival, even if they are fit for this procedure.

Comparison of Clinical Effects of Abdominal Aortic Aneurysm Treatment with Open and Endovascular Techniques

Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.

Application Effects of Total Percutaneous Technique in Endovascular Repair of Abdominal Aortic Aneurysm

Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.

Extensive complex thoracoabdominal aortic aneurysm salvaged by surgical graft providing landing zone for endovascular graft:A case report

BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,although the utilization of such techniques is limited by lesion characteristics,such as involvement of the visceral or renal arteries(RA)and/or presence of a sealing zone.CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm(CAAA)starting directly distal to the diaphragm extending to both common iliac arteries(CIAs).The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level.Due to the poor performance of the patient and the expansive disease,we planned a stepwise-combined surgery and EVAR to minimize invasiveness.A branched graft was implanted after surgical debranching of the visceral and RA.Since the patient had renal and liver injury after surgery,the second stage EVAR was performed 10 mo later.The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR.The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.

Rupture of an Infrarenal Aortic Aneurysm Due to a Secondary Type 1a Endoleak Following Endovascular Aneurysm Sealing with the Nellix^&reg;Device

Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.

Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdomi nal Aortic Aneurysm Repair:A Meta-Analysis

Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair:A case report

BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms(JAAA)usually requires combination treatment with various stent graft modifications to preserve side branch patency.As a feasible technique,according to the situation,antegrade in situ laser fenestration still needs to be improved.CASE SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial flow.Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery ostium.With the bare stent region unreleased,renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real time.CONCLUSION This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.

A Case of Thoracic Aortic Aneurysm with Hemoptysis as the First Symptom

This article reports a case of thoracic aortic aneurysm with hemoptysis as the first clinical manifestation, hemoptysis as the first clinical manifestation is very uncommon and to the best of our knowledge, only twenty of such cases have been previously reported. The case report presented here constitutes the longest course of the disease reported in medical literature, and good recovery after thoracic endovascular aortic repair, may help us to increase the understanding and diagnosis of the disease.

Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

Objective To compare clinical curative effects of open surgery （OS） or endovascular repair （EVAR） for patients with abdominal aortic aneurysm （AAA） in China. Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010. Study selection According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis. Results We analyzed a total of 2862 patients with 1757 undergoing OS （OS group） and 1105 undergoing EVAR （EVAR group）. There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group （P 〈0.01）. Low-limb ischemia, however, was more common in the EVAR group （P 〈0.05）. The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group （P 〈0.01）. In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group （P 〈0.01）. The overall late mortality rate was higher in the OS group （P 〈0.01）, especially non-aorta-related late mortality and mortality during the fourth to the sixth year （P 〈0.01）. Conclusions EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm （rAAA） obtain the greatest benefit from endovascular repair （EVAR）, convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair （OSR）. Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA （435 EVAR and 778 OSR） would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment （OR=1.81, P=0.01）, while there are more patients with hemodynamic instability before treatment in OSR group （OR=1.53, P=0.031）. Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR （weighted mean difference （WMD） 1500 ml, P=0.014）. The endovascular method was associated with a shorter stay in intensive care （WMD 2.34 days, P 〈0.001） and a shorter total post- operative stay （WMD 6.27 days, P 〈0.001）. The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group （OR=0.48, P 〈0.001 and OR=0.28, P=0.043, respectively）. The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 （95% confidence interval （CI） 0.41-0.70, P 〈0.001）. There was not, however, any significant reduction in the medium-long all-cause mortality rate （HR=1.13, P=0.381） and re-intervention rate （OR= 2.19, ,~=-0.243） following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak （OR=0.33, P=0.039） at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

Background: Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA);however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.Methods: This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.Results: A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5%vs. 80.9%;χ^(2) = 4.10;P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06;95% CI: 1.43-17.95;P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60;95% CI: 1.17-5.76;P = 0.019), and short neck (OR, 2.85;95% CI: 1.08-7.52;P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups (P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair.Conclusions: Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

西藏地区腹主动脉瘤腔内隔绝修复术的中期随访结果分析

目的分析西藏地区腹主动脉瘤(AAA)患者腔内隔绝修复手术的转归情况。方法收集2015年5月至2023年4月西藏自治区人民医院收治的31例AAA患者的临床资料,所有患者均进行了AAA腔内隔绝修复术。收集所有患者的基本特征、合并疾病、AAA最大直径、术前检查结果等信息,观察所有患者的治疗情况、围手术期并发症发生情况及随访结果。结果31例AAA患者中,美国麻醉医师协会(ASA)3级患者18例,4级患者7例。27例患者经双侧股动脉入路,4例患者经双侧股动脉和左侧肱动脉入路,手术成功率为100%。围手术期间1例患者出现臀肌跛行症状。随访时间为1~93个月。随访期间,失访2例,死亡2例,Ⅰ型内漏1例,Ⅱ型内漏1例。经随访,所有患者未发生支架移位、内漏等并发症。结论在西藏地区采用腔内隔绝修复术治疗AAA是安全、有效的。

腹主动脉瘤腔内治疗术径路血管解剖学特征及并发症的研究进展

腹主动脉瘤(AAA)是腹主动脉节段的病理性扩张,腔内治疗(EVAR)是解剖结构合适的AAA患者的首选治疗方式。径路血管作为EVAR术中穿刺以及器械输送的途径,其解剖学特征对血管并发症的发生有着显著影响。本文对EVAR径路血管解剖学特征及其并发症的研究情况进行综述。

1例EVAR术后支架感染合并全身感染病人行自体深静脉原位重建术的护理

总结1例腹主动脉瘤腔内修复术后(EVAR)支架感染合并全身感染病人行自体深静脉原位重建术的护理:术前预防瘤体破裂、积极控制感染预防休克的发生;术后做好生命体征的监测及专科观察,严格消毒隔离预防再感染发生,做好血压的控制、疼痛的管理,给予营养支持、手术伤口的护理及引流的观察,并实施心理护理;严防移植物破裂、吻合口瘘及下肢静脉高压的发生。经过积极的治疗和护理,病人术后感染控制,伤口恢复良好,未出现严重的并发症,康复出院。认为EVAR术后支架感染合并全身感染的病人病情危急,基础情况差,感染面积广,死亡率高;自体深静脉原位重建术式复杂,该手术方式对治疗和护理要求高,通过全程的管理能有效提高病人术后生存率,减少感染及并发症的发生。

Evaluation of acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair

Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population. Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage （RIFLE） kidney disease criteria. The goal-directed hemodynamic optimization （maintenance of optimal hemodynamics and neutral or negative fluid balance） and renal outcomes were also reviewed. Results Of the 71 patients enrolled, 32 （45.1%） developed AKI, with 30 （93.8%） cases diagnosed on admission to surgical intensive care unit （SICU）. Risk factors for AKI were ruptured AAA （odds ratio （OR）=5.846, 95% confidence interval （CI）： 1.346-25.390）, intraoperative hypotension （OR=6.008, 95% CI： 1.176 to 30.683）, and perioperative blood transfusion （OR=4.611, 95% CI： 1.307-16.276）. Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay （（136.9±24.5） hours vs. （70.4±11.3） hours） in Surgical Intensive Care Unit. Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.