Outcomes of Lower Extremity Revascularization (LER) in Patients on Dialysis (original) (raw)
Related papers
European Journal of Vascular and Endovascular Surgery, 2001
on behalf of the EUROSTAR Collaborators Objectives: the aim of this study was to assess the relationship between patient factors, the anatomy of the proximal aneurysm neck; the type of endovascular graft; and the consequences of graft/neck size mismatch and the occurrence of proximal endoleak. Design: multicentre clinical study. Materials: of a total of 2194 patients, 2146 underwent successful endovascular repair of infra-renal abdominal aortic aneurysms (AAA). Methods: endoleaks were identified by radiological imaging immediately after completion of the procedure as per study protocols. Clinical and anatomical features of AAA in patients with endoleak were compared to patients without endoleak and data were analysed using the Chi-square test. A multivariate logistic regression model was constructed by selecting variables found to be significantly associated with complications in a univariate analysis. Results: intra-operative endoleak was observed in 16.7% overall, and 3.3% were noted to have proximal endoleak. Aneurysm size larger than 60 mm (p=0.004), ex-smokers (p=0.005) and age over 75 years (p=0.01) were independently associated with endoleak of all types. Univariate and multivariate analysis revealed correlation between proximal endoleak and (i) diameter of the aneurysm neck-proximal (D2a), middle (D2b), distal (D2c), at all levels (p<0.005); (ii) proximal aortic neck length (p=0.0001); (iii) aortic device diameter (p=0.0024). No correlation was identified for angulation and form of the aortic neck. A model of the frequency of proximal endoleak, in relation to the ratio of the aortic device diameter to the distal aortic neck diameter, revealed that endoleak decreased when the aortic device diameter became oversized by more than 10% and confidence intervals remained tight for up to and over 20% oversize.
All dangerous types of endoleaks after endovascular aneurysm repair in a single patient
Wideochirurgia i inne techniki małoinwazyjne = Videosurgery and other miniinvasive techniques / kwartalnik pod patronatem Sekcji Wideochirurgii TChP oraz Sekcji Chirurgii Bariatrycznej TChP, 2015
Endovascular aneurysm repair (EVAR) has become tremendously popular in recent years. However, the long-term results of these stent grafts are uncertain and are still being evaluated. According to some data, the graft-related complication rate after EVAR could be as high as 43% in long-term observation. In this case report, we present a patient who had all dangerous types of endoleaks after EVAR and required sophisticated management including endovascular and open surgical repairs. After repeated invasive treatment, it was possible to exclude all endoleaks, and now the patient is free from graft-related complications. Although EVAR has become very popular, we should remember about possible complications, which could be very severe and life-threatening. For this reason, the choice between endovascular and open repair of abdominal aortic aneurysm should be well considered.
Endoleaks after endovascular repair of thoracic aortic aneurysms
Journal of Vascular Surgery, 2006
Objective: Endoleaks are one of the unique complications seen after endovascular repair of thoracic aortic aneurysms (TEVAR). This investigation was performed to evaluate the incidence and determinants of endoleaks, as well as the outcomes of secondary interventions in patients with endoleaks, after TEVAR. Methods: Over a 6-year period, 105 patients underwent TEVAR in the context of pivotal Food and Drug Administration trials with the Medtronic Talent (n ؍ 64) and Gore TAG (n ؍ 41) devices. The medical and radiology records of these patients were reviewed for this retrospective study. Of these, 69 patients (30 women and 39 men) had follow-up longer than 1 month and were used for this analysis. The patients were evaluated for the presence of an endoleak, endoleak type, aneurysm expansion, and endoleak intervention.
Journal of Endovascular Surgery, 1999
Purpose: The expansion of aneurysms after endovascular repair is a consequence of persistent sac pressure, usually resulting from an endoleak. Several authors have suggested that sac expansion can occur even in the absence of endoleak, referring to this phenomenon as endotension. This study undertakes a review of the largest US endograft trial data to better define the significance of aneurysm expansion in the absence of endoleak. Methods: The core laboratory imaging database from the Ancure (Guidant) endovascular graft Phase I and Phase II trials approved by the Food and Drug Administration was reviewed with attention to aneurysm size and endoleak. Aneurysm size was measured with standardized two-dimensional computed tomography (CT) scan at the area of largest initial aneurysm diameter. Endoleak was detected with CT scans, color duplex ultrasound scans, and angiography in selected cases. Patients were evaluated at baseline, 3 months, 6 months, 12 months, and every 12 months thereafter. An endograft was classified as leaking if any endoleak was detected with any modality at any time point. Results: A total of 658 patients were entered into these protocols and the data submitted to the core laboratory. A control group of 120 conventional aortic patients and a group of 62 without baseline CT data were excluded from further analysis. Of the remaining 476 patients, 144 (60 tube, 60 bifurcated, and 24 mono-iliac) were free of endoleak at all intervals and had baseline CT measurements to allow comparison. Overall, the average size decrease in this nonleaking group was 9.9 ± 9.4 mm (range, -50.6-11.1 mm) at a mean follow-up of 23.3 months. Evaluation for overall aneurysm expansion revealed 17 patients who had an increase of 2.3 ± 2.9 mm (range, 0.3-11.1 mm) at a mean follow-up of 14.1 months. Only two patients without evidence of endoleak exhibited growth of more than 5 mm at maximum follow-up (7.6 mm at 12 months and 11.1 mm at 36 months). Additional analysis of sealed endoleaks and late endoleaks failed to demonstrate any group with expansion in the absence of detectable endoleak.
Outcomes of persistent intraoperative type Ia endoleak after standard endovascular aneurysm repair
Journal of vascular surgery, 2015
This study analyzed outcomes for patients with persistent intraoperative type Ia endoleaks after standard endovascular aneurysm repair (EVAR). The study group was identified from a consecutive cohort of 209 patients undergoing EVAR in a tertiary center in the United Kingdom during a 2-year period. Data prospectively collected on departmental computerized databases were retrospectively analyzed. Primary outcome parameters were defined as freedom from type Ia endoleak, EVAR-related reintervention, aneurysm rupture, and aneurysm-related mortality. A completion angiogram identified 44 patients (21%) as having a type Ia endoleak, and 33 (75%) had a persistent endoleak after intraoperative adjunctive procedures, including repeated balloon moulding, aortic cuff extension, and Palmaz stent (Cordis, Miami Lakes, Fla) deployment. In the 11 patients (25%) whose endoleak was successfully abolished intraoperatively, there was no recurrence of type Ia endoleak or secondary intervention to treat t...
Fate of Pure Type II Endoleaks Following Endovascular Aneurysm Repair
Vascular Specialist International
Purpose: Type II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management. Materials and Methods: We reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement. Results: We found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs. Conclusion: T2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.
Journal of Vascular Surgery, 1998
To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. Methods: Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow-up period ranged from 1 to 44 months, with a mean value of 11 months. Results: Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-totreat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. Conclusions: Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.
BMC Surgery, 2013
Background: Endovascular repair of aortic aneurysms (EVAR) is obtained through the positioning of an aortic stent-graft, which excludes the aneurysmatic dilation. Type I endoleak is the most common complication, and it is caused by an incompetent proximal or distal attachment site, causing the separation between the stent-graft and the native arterial wall, and in turn creating direct communication between the aneurysm sac and the systemic arterial circulation. Endoleak occurrence is associated with high intrasac pressures, and requires a quick repair to prevent abdominal aortic aneurysm rupture.