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CardioVascular and Interventional Radiology 04/2013; · 2.09 Impact Factor
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ABSTRACT: OBJECTIVE: Available data on outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection are limited. This is a systematic review of outcomes of this approach. METHODS: Studies involving combined proximal stent grafting with distal bare stenting for management of aortic dissection were systematically searched and reviewed. RESULTS: A total of 4 studies were included, with 108 patients treated for acute (n = 54) and chronic (n = 54) aortic dissection. Technical success rate was 95.3% (range, 84-100). The 30-day mortality was 2.7% (range, 0%-5%). Morbidity rate within 30 days was 51.8% (range, 0%-65%) and included stroke (2.7%), paraplegia (2.7%), retrograde dissection (1.8%), renal failure (14.8%), severe cardiopulmonary complications (5.5%), and bowel ischemia (0.9%). Incidence of type I endoleak was 9.2% (10/108). During follow-up, 5 patient deaths (4.6%) were related to aortic rupture or aortic repair. Reintervention rate was from 12.9%. Two cases of delayed retrograde type A dissection (1.9%) and 1 case of aortobronchial fistula (0.9%) were reported. Most common delayed complication was thoracic stent-graft migration (4.7%). Device failure rate was 9.2%. Favorable aortic remodeling was observed: studies reporting midterm follow-up of the true lumen demonstrated high rates of false-lumen regression and true-lumen expansion. At 12 months, complete false-lumen thrombosis was observed at the thoracic level in 70.4% and at the abdominal level in 13.5%. CONCLUSIONS: Combined proximal stent grafting with distal bare stenting for management of aortic dissection appears to be a reasonable approach for type B aortic dissection, clearly improved true-lumen perfusion and diameter although failing to suppress false-lumen patency completely. Contemporary information on this approach is mainly provided by small series with a wide range of results.
The Journal of thoracic and cardiovascular surgery 03/2013; · 3.41 Impact Factor
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ABSTRACT: Morbidity and mortality have traditionally been used as key markers of surgical outcome. However, as complication rates associated with abdominal aortic aneurysm (AAA) repair decrease, subjective measures, such as quality of life (QOL), are increasingly recognized as important indicators of treatment efficacy and quality of care. This review presents the existing evidence relating to QOL changes in patients undergoing AAA repair by open repair (OR) and endovascular techniques (EVAR) and challenges current misconceptions about the relative effect of these two procedures.
A comprehensive literature search was performed to identify studies relating to QOL or health status in AAA repair. Quality of included studies was assessed according to Scottish Intercollegiate Guidelines Network methodology.
Twenty-three studies satisfied the inclusion criteria. Preoperative QOL in AAA patients has been previously suggested as being worse than that of the general population, that OR patients have a worse QOL in the early postoperative period, and that EVAR patients have a worse QOL in the longer term. None of these assertions is uniformly supported in the literature. From the existing evidence, no clear conclusions can be drawn about the relative QOL benefits of OR vs EVAR.
There are a paucity of good-quality data relating to health status and QOL in patients undergoing AAA repair. Little is known about the prevalence of preoperative or postoperative symptoms and the degree to which these influence patient well-being. Further investigation is needed to clarify health status and QOL changes in these patients and allow clinicians to make targeted improvements in practice.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 08/2012; 56(2):520-7. · 3.52 Impact Factor
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ABSTRACT: To define the reproducibility of a protocol for the analysis of infrarenal abdominal aortic aneurysm (AAA) morphology for clinical and research purposes.
A protocol for the comprehensive assessment of preoperative AAA morphology based on formal systematic review and expert opinion featured 114 morphological parameters (maximum and minimum diameters, cross-sectional areas, vessel lengths, volumes, angulation, and calcification and tortuosity indices) in each of 3 regions: the neck, sac, and access vessels. To validate the protocol, 4 observers measured these variables on the preoperative computed tomographic angiograms from 50 patients (45 men; mean age 75 years, range 52-89) scheduled for endovascular aneurysm repair using software for 3-dimensional image reconstruction. One observer performed repeated measurements. The intra- and interobserver variabilities were calculated for all parameters; measurement time for all 114 features was recorded.
Aortoiliac diameter, length, volume, area, and tortuosity index measurements showed good inter/intraobserver agreement. Aortic neck and aortoiliac angle measurements displayed high intra/interobserver repeatability coefficients (28%-43% and 29%-61%, respectively). Calcification measurements had the highest variability within and between observers: 39%-65% and 44%-96%, respectively. The measurement protocol was completed in a mean 105 minutes (range 55-420).
Accurate 3-dimensional analysis of AAA morphology can be performed reliably within a reasonable time. Measurements that relied on consistent anatomical landmarks were most reproducible. Assessment of angulation and calcification required a number of subjective judgments, increasing the potential for variation. Automated methods are likely to be more suitable for certain measurements.
Journal of Endovascular Therapy 06/2012; 19(3):400-14. · 2.86 Impact Factor
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ABSTRACT: Volume-outcome relationships in vascular surgery have become increasingly relevant in recent years. At the individual surgeon level, increased experience has been linked with improved patient outcomes after volume-outcome and learning curve analyses. At the hospital level, further analyses have generally shown a similar relationship linking the busier hospitals with improved outcomes. However, is this relationship sufficient and robust enough to support important health care delivery decisions regarding centralization of care? In England, such information has helped to shape the vascular surgery reorganization process in London. The following discussion presents the advantages and disadvantages of the practical use of such information.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2011; 54(4):1208-14. · 3.52 Impact Factor
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ABSTRACT: The visceral hybrid repair of thoracoabdominal aneurysms (TAAAs) is a feasible and relatively safe alternative to traditional open repair in a cohort of patients at high surgical risk, averting the need for thoracotomy and supra-coeliac aortic cross clamping. The visceral ischaemia-reperfusion syndrome and organ dysfunction following visceral debranching is still unkown. This study investigates the relationship between visceral ischemia and multi system organ dysfunction.
18 consecutive patients undergoing elective, urgent and emergent hybrid repair of TAAAs between February 2005 and October 2007 were prospectively analyzed. Preoperative organ dysfunction and intraoperative risk factors (operating time, extent of the aneurysm, number of visceral vessels by passed) were assessed and compared with postoperative organ dysfunction (pulmonary, hepatic, renal, pancreatic and haematological disorders). Blood sampling for neutrophil CD 11b quantification was performed at baseline, on postoperative days 1, 3, 7 and before discharge.
Perioperative Multi System Organ Dysfunction (MSOD) was diagnosed in 22.2% of patients (n = 4/18). Three of these patients died within 30 days (16.7%, n = 3/18). No relationship between preoperative organ dysfunction, blood loss, or operative time and postoperative organ dysfunction was observed. A significant correlation between the visceral retrograde revascularization and postoperative neutrophil expression in MSOD patients regardless of preoperative neutrophil baseline, TAAA extent and number of vessels by passed was present.
Upregulation of neutrophils may be responsible for the higher incidence of MSOD and it may be an important marker predicting a severe multiple organ failure following visceral debranching in hybrid procedures.
Acta bio-medica: Atenei Parmensis 04/2011; 82(1):41-50.
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ABSTRACT: The treatment of a congenital venous malformation using endovenous radiofrequency ablation in a patient is described. The patient initially underwent two treatments of foam sclerotherapy with moderate success. Later the main feeding vessel of the venous malformation became evident on examination with venous duplex and was identified as the great saphenous vein. At this point, endovenous radiofrequency ablation was used to ablate the feeding vessel and successfully treat the lesion. The procedure proceeded without complications, and the patient made a good recovery. It is recommended that patients presenting with such malformations be considered for endovenous therapy as early as possible.
Annals of Vascular Surgery 11/2009; 24(3):415.e13-7. · 1.03 Impact Factor
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ABSTRACT: Arterial diseases including atherosclerosis, intimal hyperplasia and aneurysms have been shown to be a product of genotype and environment. Gene expression pathways rely on protein translation to generate target effects. As a result of alternative splicing and post-translational modifications, one gene does not code for a single protein but for many. Proteomic studies allow quantification of these proteins in a biological system and determination of altered protein expression in disease. Proteomics is a powerful and expanding field of investigation which in combination with other 'omics may enhance understanding of disease pathophysiology and/or identify biomarkers of vascular disease. This review describes the methodology of protein mining and provides an insight into the valuable contributions already made by proteomics to vascular surgery.
MEDLINE and EMBASE databases were searched for relevant articles.
118 relevant articles were identified. These were subdivided into categories based on the aspect of protein research they reported. The subheadings include methodology, atherosclerosis, intimal hyperplasia, aortic disease and biomarkers.
Disease processes classified as genetic are functionally proteomic. Equally disease pathophysiology is the result of, or leads to alternate protein expression. Understanding the proteome will clarify the pathophysiology of disease. The translation of these findings to clinical practice impacts diagnosis, staging and treatment of disease processes. Biomarker discovery will enable earlier diagnosis of unstable atherosclerotic plaques, it will allow identification of aneurysms more likely to rupture and stratify risk. Proteomic research has enormous potential to modulate many aspects of patient care.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2009; 49(6):1602-12. · 3.52 Impact Factor
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ABSTRACT: We sought to report our experience with combined retrograde visceral revascularization and endovascular exclusion (hybrid procedure) of thoracoabdominal aortic aneurysms.
From February 2005 to October 2007, the prospectively collected data of 18 consecutive patients undergoing hybrid repair were analyzed. Median age was 73 years; Crawford-Safi extent included 2 type I, 8 type II, 7 type III, and 1 type V thoracoabdominal aortic aneurysms; 13 were atherosclerotic and 5 were postdissecting aneurysms. Previous open or endovascular aortic surgery had been performed in 11 (61.1%) patients. Society for Vascular Surgery/North American Chapter of the International Society for Cardiovascular Surgery preoperative risk stratification identified mild-to-severe hypertension and pulmonary and cardiac status in 88.9%, 67.7%, and 88.9% of the patients, respectively.
Fifty-four visceral vessels were bypassed in 18 patients. As an adequate inflow site, the common iliac artery was identified in 15 (83.3%) patients, the infrarenal native aorta was identified in 1 (5.6%) patient, and a previous tube graft was identified in 2 (11.1%) patients. Median operating time was 360 minutes (range, 210-600 minutes), and median blood loss was 3200 mL (range, 1000-18,000 mL). Aneurysm exclusion was achieved in 17 patients. Thirty-day mortality was 16.7% (n = 3/18). Complications included paraplegia (n = 1) and acute myocardial infarction (n = 2). Median follow-up was 23 months (range, 8-42 months), with visceral graft patency at follow-up or death of 98.1% (n = 53/54). One early and 1 late type Ia endoleak (11.8%, n = 2/17), no type III endoleaks, and 5 type II endoleaks were detected, none necessitating adjuvant procedures.
The visceral hybrid repair is a feasible and relatively safe procedure for extensive thoracoabdominal aortic aneurysms. Even considering the significantly high mortality and morbidity rates, it might represent a viable alternative in a cohort of patients historically deemed at high risk for traditional surgical intervention.
The Journal of thoracic and cardiovascular surgery 06/2009; 138(6):1331-8. · 3.41 Impact Factor
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ABSTRACT: Reintervention following endovascular aneurysm repair (EVAR) is required in up to 10% of patients at 30 days and is associated with a demonstrable risk of increased mortality. Completion angiography cannot detect all graft-related anomalies and computed tomographic angiography is therefore mandatory to ensure clinical success. Intraoperative angiographic computed tomography (DynaCT; Siemens, Germany) utilizes cone beam reconstruction software and flat-panel detectors to generate CT-like images from rotational angiographic acquisitions. We report the intraoperative use of this novel technology in detecting and immediately treating a proximal anterior type Ia endoleak, following an endovascular abdominal aortic repair, which was not seen on completion angiography. Immediate evaluation of cross-sectional imaging following endograft deployment may allow for on-table correction of clinically significant stent-related complications. This should both improve technical success and minimize the need for early secondary intervention following EVAR.
CardioVascular and Interventional Radiology 05/2009; 32(3):535-8. · 2.09 Impact Factor
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ABSTRACT: To evaluate feasibility, technical success, and the need for reintervention in the early perioperative period, following the introduction of intraoperative DynaCT (DynaCT, Siemens AG, Berlin, Germany) in patients undergoing infrarenal endovascular aneurysm repair (EVAR). DynaCT involves the generation of computed tomography (CT)-like images from "on table" rotational angiographic acquisition.
A prospectively maintained database of 312 patients undergoing EVAR (September 2001 - February 2007) was interrogated to determine incidence of early reintervention following satisfactory appearances of uniplanar completion angiography (control group). Following the introduction of DynaCT (DynaCT group - 80 patients), clinical and radiologic outcomes were prospectively evaluated (September 2007 - May 2008). Both groups underwent pre-discharge computed tomographic angiography (CTA) and color-flow duplex scan. Comparative analysis of procedural data, hospital-stay, mortality, and early reintervention between the two groups was undertaken.
In the control group, 14 (4.5%) patients required reintervention procedures within 30 days of EVAR (10 endovascular, 7 surgical). Six patients had type 1 endoleaks and 8 presented with acute limb ischemia. Review of this cohort suggested that the majority of complications (86%) may have been immediately identifiable with improved intra-operative quality control. In the DynaCT group, DynaCT was feasible in 81.3% (n = 65/80) of patients and resulted in the detection of five clinically significant anomalies (6.25%, n = 5/80). These technical problems were not identified at completion angiography but were corrected after DynaCT (2 type 1 endoleaks, 1 type 3 endoleak, 1 limb compression, and 1 graft thrombosis). Standard pre-discharge imaging did not identify any further graft-related complications in the DynaCT group. Introduction of DynaCT resulted in a reduced need for early reintervention (0/80 vs 14/312, P = .05).
Most graft-related complications that mandate early reintervention following EVAR are due to remediable technical problems which are not identified by uniplanar completion angiography alone. DynaCT is a feasible intra-operative adjunct to completion angiography, which improves intra-operative quality control during endovascular repair of abdominal aortic aneurysms.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2008; 49(2):288-95. · 3.52 Impact Factor
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ABSTRACT: Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.
CardioVascular and Interventional Radiology 04/2008; 31(4):821-3. · 2.09 Impact Factor
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ABSTRACT: Patients with aneurysmal dissections involving both the thoracic and the abdominal aorta are particularly challenging to treat with endovascular techniques because of the natural communications at the level of the visceral arteries. We present the case of a patient with Marfan syndrome with an aneurysmal aortic dissection involving the thoracic and abdominal aorta who was treated by a combination of endografts, surgical bypass, and a fenestrated tube graft.
CardioVascular and Interventional Radiology 02/2008; 31 Suppl 2:S72-6. · 2.09 Impact Factor
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ABSTRACT: Circulating plasma interleukin-6 (IL-6) concentrations are elevated in patients with abdominal aortic aneurysms (AAAs) compared with controls. In vitro studies suggest that the aneurysm is the source of the IL-6. Because IL-6 is an independent risk factor for cardiovascular mortality, elevation of this cytokine may be significant in these patients, who represent a group at increased risk from cardiovascular death. The aim of this study was to directly measure in vivo aortic IL-6 concentrations, testing the hypothesis that aneurysms secrete IL-6 into the circulation.
Before endovascular aneurysm repair took place, blood was sampled from the entire length of the aorta in 27 patients with AAA and nine with thoracic aneurysms (TAs). A control group consisted of 15 patients without aneurysms undergoing angiography. Plasma IL-6 was determined using enzyme-linked immunosorbent assay, and high-sensitivity C-reactive protein (hs-CRP) was measured turbidimetrically. Aneurysm surface area was calculated from axial computed tomography scans.
Mean IL-6 concentrations (pg/mL) were higher in the TA and AAA groups compared with controls (10.4 +/- 3.7 and 4.9 +/- 0.5 vs 2.7 +/- 0.5, P = .002). There was a significant difference in plasma IL-6 concentration corresponding to aneurysm position in the AAA (P = .002) and TA (P = .008) groups, with both patterns conforming to a linear trend. This pattern was not observed in the control group, in which no significant difference in IL-6 concentrations was found throughout the aorta. Peak IL-6 occurred earlier in TAs compared with AAAs (descending aorta vs iliac artery) corresponding to aneurysm position (P = .0007). Linear regression revealed a positive correlation between aneurysm surface area and mean plasma IL-6 (Spearman's correlation, P = .003). The mean surface areas of the TAs, at 0.07 m2 (interquartile range [IQR], 0.06 to 0.09), were higher than those of the AAAs at 0.03 m2 (IQR, 0.02 to 0.04; P = .002). High-sensitivity CRP was within normal limits, and no significant differences were found between the AAA group and the controls.
Circulating IL-6 is elevated within the aorta in patients with aneurysms and corresponds to aneurysm position. Furthermore, aneurysm surface area and mean plasma IL-6 are correlated. In the absence of any evidence of systemic inflammation in the form of elevated hs-CRP, these data support the hypothesis that aneurysms secrete IL-6 into the circulation. This may contribute to the high cardiovascular mortality observed in patients with aneurysms.
Journal of Vascular Surgery 03/2007; 45(2):350-6. · 3.21 Impact Factor
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ABSTRACT: Studies suggest that aneurysm-derived cytokines perpetuate the cycle of inflammation and proteolysis that is the pathological hallmark of abdominal aortic aneurysms (AAA). As interleukin (IL)-6 is an independent risk factor for cardiovascular mortality, such cytokines may also have important systemic effects. The purpose of this study was to investigate the effect of aneurysm repair on circulating levels of cytokines. Inflammatory cytokines were measured in 99 patients with AAA and 100 patients who had undergone AAA repair in the past. There was a significant reduction in IL-10 in the postoperative group, and a nonsignificant trend toward reduction in IL-6 and CRP in the postoperative group. Subgroup analysis of the postoperative group revealed significantly lower levels of IL-6 and CRP in the open group compared to endovascular aneurysm repair (EVAR). These results suggest that aneurysm repair may have an effect upon chronic levels of circulating inflammatory cytokines, and that the type of repair may exert some influence.
Annals of the New York Academy of Sciences 12/2006; 1085:324-6. · 3.15 Impact Factor
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ABSTRACT: Endothelial progenitor cells (EPCs) are a population of circulating stem cells that hone in to sites of vascular injury where they undergo differentiation to become incorporated into damaged tissue. The aim of this study was to enumerate EPCs in patients with abdominal aortic aneurysms (AAA). CD133(+) peripheral blood mononuclear cells were immunomagnetically selected and CD34/CD133 was used as a marker of EPCs. EPCs were detected using flow cytometry. AAA patients had significantly higher levels of circulating EPCs than age-matched controls (2.43% vs. 1.25% of all events, P = 0.008). The role and function of EPCs in AAA remain to be determined, but their implication with angiogenesis may represent one plausible mechanism.
Annals of the New York Academy of Sciences 12/2006; 1085:327-30. · 3.15 Impact Factor
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ABSTRACT: In keeping with the inflammatory paradigm of abdominal aortic aneurysm (AAA) pathophysiology, in vitro studies suggest that aneurysms secrete the proinflammatory cytokine interleukin-6 (IL-6). Circulating IL-6 levels are higher in patients with AAA with elevated circulating IL-6 an independent risk factor for cardiovascular mortality. To investigate whether aneurysms secrete IL-6 into the circulation, arterial IL-6 was measured from within the aorta in three groups of patients undergoing endovascular procedures; 27 AAA, 10 thoracic aneurysms (TA), and 15 controls. Overall, IL-6 was higher in the aneurysm groups (P < 0.0008) with significant rises corresponding to positions downstream to the aneurysm in both AAA and TA. There were no significant differences in IL-6 with aortic position in the control group. These data support the hypothesis that aneurysms secrete IL-6 into the circulation and may account for the high cardiovascular mortality observed in patients with aneurysms.
Annals of the New York Academy of Sciences 11/2006; 1085:320-3. · 3.15 Impact Factor
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ABSTRACT: Aortic aneurysms account for 10,000 deaths annually in the UK, due to rupture. At present the only effective therapeutic strategy to treat abdominal aortic aneurysms is to surgically repair them; this carries an elective mortality of up to 10%. Recent advances in vascular biology have led to a greater understanding of the pathophysiological process that causes aortic aneurysms to expand and rupture. Key pathological processes include widespread aortic inflammation, proteolytic degradation of the extracellular matrix, neovascularisation and generation of reactive oxygen species. Identification of these processes has lead to pharmacological strategies to prevent aneurysm expansion and rupture. Many of these strategies have undergone proof of concept in animal models and some have now entered clinical trials. This review outlines current thinking regarding the molecular events leading to aneurysm expansion and explains how these processes may be inhibited. Experimental data on agents retarding aneurysm expansion in animal models are discussed. A significant proportion of the review details pharmacological agents that have undergone or are undergoing clinical trials. Pharmacological treatment for abdominal aneurysms is urgently required given the number of small aneurysms being diagnosed by screening programmes. This is a rapidly evolving field and one in which translation from experimental research to clinical practice is anticipated within 5 years.
Current Vascular Pharmacology 05/2006; 4(2):129-49. · 2.90 Impact Factor
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Matt Thompson,
Stella Ivaz,
Nicholas Cheshire,
Rosella Fattori,
Herve Rousseau,
Robin Heijmen,
Jean-Paul Beregi,
Frederic Thony,
Gillian Horne,
Robert Morgan, Ian Loftus
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ABSTRACT: Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology. Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts. Data were retrospectively collected on 180 patients treated with the Valiant endograft at seven European centers between March 2005 and October 2006. The patient cohort consisted of 66 patients with thoracic aneurysms, 22 with thoracoabdominal aneurysms, 19 with an acute aortic syndrome, 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection. The overall 30-day mortality for the series was 7.2%, with a stroke rate of 3.8% and a paraplegia rate of 3.3%. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms (6.1%), thoracoabdominal aneurysms (27.3%), acute aortic syndrome (10.5%), chronic dissections (1.9%), and acute transections (0%). Adjunctive surgical procedures were required in 63 patients, and 51% of patients had grafts deployed proximal to the left subclavian artery. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology. Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity.
CardioVascular and Interventional Radiology 30(6):1130-8. · 2.09 Impact Factor
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ABSTRACT: The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy.
Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 degrees, circumferential thrombus >50%, and length <10 mm. Eighty-seven patients with 0 adverse features (good necks) were compared with 60 patients with one or more adverse features (hostile necks).
Comparing the good neck with the hostile neck group, there were no significant differences in the incidence of primary technical success (p = 0.15), intraoperative adjunctive procedures (p = 0.22), early proximal type I endoleak (<30 days) (p = 1.0), late proximal type I endoleak (>30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p = 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04).
Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy.
CardioVascular and Interventional Radiology 29(6):975-80. · 2.09 Impact Factor
