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Endovascular Implants
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Elazer Edelman, Lambros Athanasiou, Farhad Rikhtegar Nezami
The vessel wall can also dissect when, similar to aneurysms, hemodynamic forces lead to tear initiation of the aortic wall, allowing blood to flow within its layers (Criado, 2011) and creating two rather than one lumen: the true lumen that is anatomo-physiologically correct and the false lumen. Aortic dissection is a significant and growing condition in aging populations. The extension of aortic dissection determines the severity of the disease and is a determinant mortality factor (Fattori et al., 2013). Dissections are classified by their involvement of ascending and transverse as opposed to the descending aorta (Mokashi and Svensson, 2019). Their treatment involves eliminating the false lumen and restoring the physiologic flow to the true lumen. Those that involve the ascending aorta can be repaired surgically; however, once the tear extends distally into the descending aorta critical branch vessels limit surgical approaches. Endovascular aneurysm repair techniques have been introduced, and new devices, such as branched and fenestrated aortic stent-grafts, have been developed (Wong et al., 2011; Ruffino and Rabbia, 2012; Rikhtegar Nezami et al., 2018; Stefanov et al., 2017; Sultan et al., 2016a).
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
For this patient, the management may be via an endovascular aneurysm repair, otherwise known as EVAR, which is known to be the most effective repair; however, this is dependent upon the aortoiliac anatomy, which is not available in this patient. If an EVAR procedure cannot be performed then an open aneurysm repair can be attempted. Unfortunately, most patients who suffer an aneurysm do not reach the operating room. The mortality for those patients who are operated on is 50%.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
Aneurysms: The UK endovascular aneurysm repair (EVAR) trials22 showed a clear operative mortality benefit of EVAR over open repair in patients fit for both procedures. However, no long-term survival advantage was found. For patients unfit for open repair, EVAR reduces long-term AAA-related mortality but not all-cause mortality.DREAM is a Dutch study similar to EVAR-1OVER is a USA study similar to EVAR-1IMPROVE is a multicentre study to compare rupture AAA with open and endovascular stenting. The study treats all comers with a rupture aneurysm. Overall survival is very similar.
Umbrella review and meta-analysis of reconstructed individual patient data of mortality following conventional endovascular and open surgical repair of infrarenal abdominal aortic aneurysm
Published in Expert Review of Cardiovascular Therapy, 2023
Vladica M. Veličković, Daniel Carradice, Jonathan R Boyle, Mohamad Hamady, Trevor Cleveland, Simon Neequaye, Aleksandra Ignjatović, Dragana Bogdanović, Jelena Savovic, Uwe Siebert
Two treatment modalities are currently available for AAA: endovascular aneurysm repair (EVAR) and open surgical repair (OSR) [8]. Based on data from the UK National Vascular Registry early (in-hospital) mortality is lower following EVAR vs. OSR (0.4% vs. 2.3%, respectively) [9]. However, concerns have been raised over reported higher long-term mortality following EVAR [8]. This fact has led to considerable clinical uncertainty in decision-making, with some physicians preferentially offering OSR to younger and lower risk patients who would benefit from improved long-term survival at the cost of a potential increase in in-hospital mortality and morbidity [10]. Others believe that improvements in case selection, planning, procedural strategies, device technology, surveillance and the long-term management of grafts and their complications have addressed the deficiencies seen in EVAR 1, yielding similar long-term results. Extremely high variation in EVAR utilization has resulted. For example, in the UK, the use of EVAR to treat screen-detected AAA ranged between 20% and 97% across the regional programs [11], and there is also significant variation in EVAR use globally [12].
Profile of the Ovation ALTO abdominal stent graft for the treatment of abdominal aortic aneurysms: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Mark Gregory, Matt Metcalfe, Kate Steiner
The 5-year follow up data from the ENCORE database are highly satisfactory, demonstrating a freedom from aneurysm related mortality rate of 99.3%. Freedom from type 1A endoleak was found to be 95.8% and freedom from sac expansion 84.9% [48]. Of the patients in the database, 50% were found to have complex aortic anatomy, (defined as one of: neck length <10 mm, neck angle >60°, reverse neck taper >10%, distal common iliac artery diameter <10 mm, or external iliac artery diameter <6 mm). Despite the high rate of complex anatomy, technical success was achieved in 99.7% of cases and the 30-day mortality rate only 0.3% [48]. Direct comparative data between devices in comparable aneurysm anatomy is highly limited, however it is useful to note that in one multicentre study endovascular aneurysm repair with the Ovation stent graft achieved favorable 5-year results, where 41% of the patients had anatomy deemed unsuitable for other stent grafts [47].
Conservative treatment of non-aneurysmal infectious aortitis: a case report and review of the literature
Published in Acta Clinica Belgica, 2019
Jasper Callemeyn, Kim Daenens, Inge Derdelinckx, Steven Dymarkowski, Katleen Fagard
Surgery aims at removal of the infected tissue, restoration of the arterial flow and can provide additional microbiological information through perioperative biopsy. The revascularization technique largely depends on the location and extent of disease. In general, an extra-anatomical bypass graft is used in cases of severe infection with purulent periaortic tissue, whereas an in situ graft is reserved for contained infection or a suprarenal aneurysm [20]. Endovascular aneurysm repair (EVAR) has become a popular alternative for open surgery. The less invasive character allows for surgery in comorbid patients and provides a rapid and efficient measure to obtain hemodynamic stability. Although a suboptimal infectious source control with this technique was initially presumed, favorable results for the treatment of aneurysmal infectious aortitis have been reported in the literature [24,25].