Chapter 72 - Aortoiliac aneurysm - endovascular treatment Flashcards
(47 cards)
Volodos 1986
first description of EVAR
Parodi 1990
First EVAR
When was EVAR first approved in Europe and US
Europe 1996 US 1999
Early models of EVAR grafts
AneuRx (Medtronic) - low profile, high migration Vanguard (Boston) - fabric tears and perf Excluder (Gore) - Type IV due to pores Talent - spring fractures and C-bar breaks AFX - passive fixation and sits at aortic bifurcation Aorfix - only graft with IFU 90 degree angulated necks
Perclose IFU size recommendations
1 perclose: 5-8F 2 percloses: - 8.5-21F
EVAR1 key points
1) UK study 2) 1082 patients fit for open 3) 1999-2003 4) 30d mortality 1.7 vs 4.7% 5) secondary intervention 9.8 vs 5.8%
DREAM key points
1) Multicenter 2) 345 patients 3) 2000-2003 4) Mortality 1.2 vs 4.6% 5) mortality and morbidity 4.7 vs 9.8% (mostly pulmonary)
OVER key points
1) 42 veteran affairs centres 2) 881 patients 3) mortality 0.5 vs 3% 4) 2 year mortality 7.0 vs 9.8%
FRENCH study on EVAR vs OPEN
in low to moderate risk patients there’s no difference between EVAR and open
EVAR1 long term outcome
1) 6 year no difference but only 24% had follow up 2) Initial benefit lost in 2 years 3) Higher graft-related complication needing reintervention at 4 years in EVAR
DREAM long term results
1) 2 year 2.1 vs 5.7% aneurysm-related mortality 2) all mortality same 3) higher reintervention at 6 year in EVAR 30 vs 19.1
OVER long term results
3 years EVAR and open converge in outcome
EUROSTAR registration on reintervention and rupture in EVAR
5% reintervention Rupture 1%/year
MEDICARE on follow up post EVAR
50% lost to f/u at 5 year
Difference in MEDICARE 2001-2004 vs 2003-2007
2001-2004: EVAR increases reintervention, rupture, long term mortality 2003-2007: sustained benefit at 5.7 years of EVAR
EVAR 2 key points
1) EVAR vs medical management 2) 338 patients 3) no difference in mortality…possible reasons: a) patients died waiting EVAR b) 25% medical group crossed to EVAR Conclusion: EVAR not indicated in high risk patients
EUROSTAR on different grafts (Aneurx, talent, zeneth, exluder)
Aneurx and Talent: higher migration and endoleak (I and III) Zeneth: higher sac shrinkage, limb occlusion; lowest migration Excluder: least limb occlusion
Forces required to migrate different grafts
Sewn on grafts: 150N Zenith: 24N Ancure: 12.5N Vanguard 9N Talent 4.5N
Patency of Aortouni with fem-fem bypass
90.9% at 54 months 97.7% primary patency at 66 months 100% secondary patency at 66 months
Rate of type 2 endoleak on post-op CT
10-20%
Type 2 endoleak natural course
80% resolve in 12 months no correlation with rupture based on EUROSTAR
Options/approach to treating type 2 endoleak
1) Transarterial 2) Translumbar
Type III endoleak rate
0-1.5%
Duplex sensitivity for endoleaks
67%
