Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery
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Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery. / Spanos, Konstantinos; Kölbel, Tilo; Kouvelos, George; Tsilimparis, Nikolaos; Debus, Sebastian E; Giannoukas, Athanasios D.
In: J CARDIOVASC SURG, Vol. 61, No. 2, 04.2020, p. 159-170.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery
AU - Spanos, Konstantinos
AU - Kölbel, Tilo
AU - Kouvelos, George
AU - Tsilimparis, Nikolaos
AU - Debus, Sebastian E
AU - Giannoukas, Athanasios D
PY - 2020/4
Y1 - 2020/4
N2 - INTRODUCTION: The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease.EVIDENCE ACQUISITION: A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery.EVIDENCE SYNTHESIS: Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350).CONCLUSIONS: Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.
AB - INTRODUCTION: The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease.EVIDENCE ACQUISITION: A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery.EVIDENCE SYNTHESIS: Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350).CONCLUSIONS: Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.
KW - Aged
KW - Anastomosis, Surgical/adverse effects
KW - Aneurysm, False/etiology
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Aortography/methods
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Cause of Death
KW - Endoleak/surgery
KW - Endovascular Procedures/methods
KW - Female
KW - Follow-Up Studies
KW - Hospital Mortality
KW - Humans
KW - Laparotomy/methods
KW - Male
KW - Postoperative Complications/diagnostic imaging
KW - Prognosis
KW - Reoperation/methods
KW - Risk Assessment
KW - Survival Analysis
KW - Treatment Outcome
U2 - 10.23736/S0021-9509.18.10145-5
DO - 10.23736/S0021-9509.18.10145-5
M3 - SCORING: Journal article
C2 - 29430886
VL - 61
SP - 159
EP - 170
JO - J CARDIOVASC SURG
JF - J CARDIOVASC SURG
SN - 0021-9509
IS - 2
ER -
