Secondary Endovascular Repair of Recurring Lesions and Perioperative Complications after Open Aortic Repair: The Complementary Role of Different Technical Solutions.
Aged
Angioplasty, Balloon
/ adverse effects
Aorta
/ diagnostic imaging
Aortic Diseases
/ diagnostic imaging
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
/ adverse effects
Humans
Male
Middle Aged
Postoperative Complications
/ diagnostic imaging
Recurrence
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome
Vascular Surgical Procedures
/ adverse effects
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
22
03
2019
revised:
27
04
2019
accepted:
02
06
2019
pubmed:
27
8
2019
medline:
7
7
2020
entrez:
27
8
2019
Statut:
ppublish
Résumé
The aim of our article was to describe the complementary role of different technical solutions for secondary endovascular repair of recurring lesions and perioperative complications after open aortic repair (OAR). We describe our clinical experience of secondary endovascular repair after OAR. We included in the analysis all consecutive patients who presented recurring lesions and perioperative complications after OAR and underwent secondary endovascular repair between January 1, 2015 and June 31, 2018. Both elective and nonelective cases were captured. Early end points were technical success, 30-day mortality, 30-day major adverse events, and 30-day vascular access complications. Late end points were survival and freedom from secondary interventions. Three different techniques were used in 6 patients: 2 cases of fenestrated-branched endovascular aortic repair (F-BEVAR), 2 cases of parallel-graft EVAR (pg-EVAR), and 2 cases of off-label use of standard devices. Technical success was 100%. One patient died within 30 days from acute pulmonary embolism. One patient developed acute kidney injury not requiring renal replacement therapy, whereas the remaining 4 patients were free from 30-day major adverse events. The cumulative rate of 30-day vascular access complications was 0%. All the 5 patients who survived the index hospitalization had ≥12 months of clinical and imaging follow-up. At the longest individual follow-up, they all were alive and free from secondary interventions. Computed tomography angiography showed in all cases sustained clinical success. Secondary endovascular repair of recurring lesions and perioperative complications after OAR is safe and feasible and offers a minimally invasive effective treatment option when a redo surgical operation would be associated with a considerable risk to the patient. Different solutions are available (including F-BEVAR, pg-EVAR, and off-label use of standard devices) and are complementary rather than competitive. Careful preoperative assessment and familiarity with advanced techniques are essential to achieve satisfactory outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of our article was to describe the complementary role of different technical solutions for secondary endovascular repair of recurring lesions and perioperative complications after open aortic repair (OAR).
METHODS
METHODS
We describe our clinical experience of secondary endovascular repair after OAR. We included in the analysis all consecutive patients who presented recurring lesions and perioperative complications after OAR and underwent secondary endovascular repair between January 1, 2015 and June 31, 2018. Both elective and nonelective cases were captured. Early end points were technical success, 30-day mortality, 30-day major adverse events, and 30-day vascular access complications. Late end points were survival and freedom from secondary interventions.
RESULTS
RESULTS
Three different techniques were used in 6 patients: 2 cases of fenestrated-branched endovascular aortic repair (F-BEVAR), 2 cases of parallel-graft EVAR (pg-EVAR), and 2 cases of off-label use of standard devices. Technical success was 100%. One patient died within 30 days from acute pulmonary embolism. One patient developed acute kidney injury not requiring renal replacement therapy, whereas the remaining 4 patients were free from 30-day major adverse events. The cumulative rate of 30-day vascular access complications was 0%. All the 5 patients who survived the index hospitalization had ≥12 months of clinical and imaging follow-up. At the longest individual follow-up, they all were alive and free from secondary interventions. Computed tomography angiography showed in all cases sustained clinical success.
CONCLUSIONS
CONCLUSIONS
Secondary endovascular repair of recurring lesions and perioperative complications after OAR is safe and feasible and offers a minimally invasive effective treatment option when a redo surgical operation would be associated with a considerable risk to the patient. Different solutions are available (including F-BEVAR, pg-EVAR, and off-label use of standard devices) and are complementary rather than competitive. Careful preoperative assessment and familiarity with advanced techniques are essential to achieve satisfactory outcomes.
Identifiants
pubmed: 31449951
pii: S0890-5096(19)30590-4
doi: 10.1016/j.avsg.2019.06.015
pii:
doi:
Types de publication
Case Reports
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
99-107Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.