Luis A Sanchez

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (79)128.89 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to evaluate postapproval outcomes of patients with juxtarenal aortic aneurysms treated with the Zenith fenestrated endovascular graft (Cook Inc, Bloomington, Ind). We reviewed clinical data of consecutive patients treated with the Zenith fenestrated endovascular graft in the United States at seven institutions with early commercial access from July 2012 to December 2012. Clinical outcomes and compliance to anatomic guidelines were compared with results of the U.S. fenestrated trial (USFT). Fifty-seven patients were treated. There were significantly more (P < .05) patients with coronary artery disease, myocardial infarction, and preoperative renal insufficiency than in the USFT. Thirty-six patients (63.2%) did not meet the USFT anatomic criteria of a >4-mm infrarenal neck, and there were significantly more mesenteric stents (13 vs 0; P < .05) used in this group than in the USFT, reflecting the higher anatomic complexity of these patients. The total operative time was 250.2 ± 14.8 minutes, the fluoroscopy time was 68.9 ± 4.47 minutes, and the average volume of contrast material was 108.6 ± 5.6 mL. Technical success was 100% in regard to aneurysm exclusion, although the left renal fenestration was not able to be aligned in two patients, and one patient had a kinked renal stent that was successfully restented. During this time period, there were a total of 10 endoleaks, of which two were type III and eight were type II. Despite higher rates of comorbidities and more challenging anatomy, early 30-day outcomes of juxtarenal aortic aneurysms treated postapproval with the Zenith fenestrated endovascular graft compare well with USFT data. Future studies are needed to assess durability of this treatment modality as the technology diffuses and data mature.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2014; · 3.52 Impact Factor
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    ABSTRACT: Objective This study reports the results of a prospective, multicenter trial designed to evaluate the safety and effectiveness of the Zenith fenestrated endovascular graft (Cook Medical, Bloomington, Ind) for treatment of juxtarenal abdominal aortic aneurysms (AAAs). Methods Sixty-seven patients with juxtarenal AAAs were prospectively enrolled in 14 centers in the United States from 2005 to 2012. Custom-made fenestrated stent grafts were designed with one to three fenestrations on the basis of analysis of computed tomography data sets. Renal alignment was performed with balloon-expandable stents. Follow-up included clinical examination, laboratory studies, mesenteric-renal duplex ultrasound, abdominal radiography, and computed tomography imaging at hospital discharge and at 1 month, 6 months, and 12 months and yearly thereafter up to 5 years. Results There were 54 male and 13 female patients with a mean age of 74 ± 8 years enrolled. Mean aneurysm diameter was 60 ± 10 mm. A total of 178 visceral arteries required incorporation with small fenestrations in 118, scallops in 51, and large fenestrations in nine. Of these, all 118 small fenestrations (100%), eight of the scallops (16%), and one of the large fenestrations (11%) were aligned by stents. Technical success was 100%. There was one postoperative death within 30 days (1.5%). Mean length of hospital stay was 3.3 ± 2.1 days. No aneurysm ruptures or conversions were noted during a mean follow-up of 37 ± 17 months (range, 3-65 months). Two patients (3%) had migration ≥10 mm with no endoleak, both due to cranial progression of aortic disease. Of a total of 129 renal arteries targeted by a fenestration, there were four (3%) renal artery occlusions and 12 (9%) stenoses. Fifteen patients (22%) required secondary interventions for renal artery stenosis/occlusion in 11 patients, type II endoleak in three patients, and type I endoleak in one patient. At 5 years, patient survival was 91% ± 4%, and freedom from major adverse events was 79% ± 6%; primary and secondary patency of targeted renal arteries was 81% ± 5% and 97% ± 2%, freedom from renal function deterioration was 91% ± 5%, and freedom from secondary interventions was 63% ± 9%. Conclusions This prospective study demonstrates that endovascular repair of juxtarenal AAAs with the Zenith fenestrated AAA stent graft is safe and effective. Mortality and morbidity are low in properly selected patients treated in centers with experience in these procedures.
    Journal of Vascular Surgery. 01/2014;
  • Jeffrey Jim, Francis J Caputo, Luis A Sanchez
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    ABSTRACT: Intentional coverage of the celiac artery (CA) can extend the distal landing zone necessary for thoracic endovascular aortic repair. A comprehensive review identified 93 cases in 17 reports describing this technique. The majority (87%) were elective procedures. Prior to endograft deployment, 21 patients underwent CA embolization. Of the remaining, three developed type II endoleaks from the CA requiring treatment. The superior mesenteric artery (SMA) was stented in 18 patients during the operative procedure, with one patient undergoing delayed stent placement. There were five iliac artery injuries but no other intraoperative complications. The 30-day mortality rate was 9.7% with three cases attributed to foregut ischemia. Overall, this procedure is technically safe but is associated with a significant risk of death and morbidity. Furthermore, durability is unclear as long-term data are lacking. Careful patient selection, preoperative determination of adequate CA-SMA collaterals, and demonstration of postprocedure SMA patency are all mandatory components of this procedure. However, the development of foregut ischemia cannot be reliably predicted, and patients should be monitored closely for this unique postoperative complication.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2013; · 3.52 Impact Factor
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    ABSTRACT: The purpose of this case report is to describe the use of thoracic endografts in endovascular repair of abdominal aortic aneurysms (AAAs) with large-diameter aortic necks. We present four patients who underwent elective repair of AAAs. Preoperative imaging demonstrated all to have large aortic necks (35-37 mm) precluding treatment with standard abdominal aortic devices. All underwent endovascular treatment, which included the use of a Zenith TX2 endograft (Cook Medical Incorporated, Bloomington, IN, USA) as a proximal aortic cuff. There was 100% technical success. One patient developed gastrointestinal bleeding and a myocardial infarction. All were subsequently discharged home. On follow-up, there was one aneurysm-related death at three months. The remaining three patients are alive at a mean of 25.7 months after their operation. In conclusion, large proximal aortic necks preclude endovascular treatment with standard abdominal endograft components. The use of a thoracic endograft as a proximal aortic cuff is a feasible technique for patients unable to tolerate open aortic reconstruction.
    Vascular 03/2012; 20(2):113-7. · 0.86 Impact Factor
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    ABSTRACT: Tumors of the neck of the pancreas may involve the superior mesenteric and portal veins as well as the termination of the splenic vein. This presents a difficult problem since the pancreas cannot be transected through the neck as is standard in a Whipple procedure. Here, we present our method of resecting such tumors, which we term "Whipple at the Splenic Artery (WATSA)". The superior mesenteric and portal veins are isolated below and above the pancreas, respectively. The pancreas and splenic vein are divided just to the right of the point that the splenic artery contacts the superior border of the pancreas. This plane of transection is approximately 2 cm to the left of the pancreatic neck and away from the tumor. The superior mesenteric artery is cleared from the left side of the patient. With the specimen remaining attached only by the superior mesenteric and portal veins, these structures are clamped and divided. Reconstruction is performed with or without a superficial femoral vein graft. The splenic vein is not reconstructed. Ten cases have been performed to date without mortality. We have previously shown that the pattern of venous collateral development following occlusion of the termination of the splenic vein in the manner described is not similar to that of cases of sinistral (left sided) portal hypertension. Whipple at the splenic artery (WATSA) is a safe method for resection of tumors of the neck of the pancreas with vein involvement. It should be performed in high-volume pancreatic surgery centers.
    Journal of Gastrointestinal Surgery 03/2012; 16(5):1048-54. · 2.36 Impact Factor
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    ABSTRACT: Type II endoleak (T2EL) with aneurysm expansion is believed to place patients at risk for aneurysm-related mortality (ARM). Treatment with glue and/or coil embolization of the aneurysm sac, inferior mesenteric artery (IMA), and lumbar branches via translumbar or transarterial approaches has been utilized to ablate such endoleaks, and thus decrease ARM. We evaluated the midterm results of percutaneous endovascular treatment of T2EL with aneurysm expansion. Single-institution, 5-year (January 2003 to August 2008) retrospective study of all endovascular interventions for T2EL with sac expansion. Blinded, independent review of all available pre- and post-T2EL intervention computed tomography (CT) scans was performed. Aneurysm sac maximal transverse diameters and aneurysm sac growth rates prior to and following T2EL intervention were analyzed. Forty-two patients (34 male, eight female; mean age, 75) underwent T2EL intervention at 26 ± 20 months after endovascular aneurysm repair (EVAR) and were subsequently followed for 23 ± 20 months. Seven out of 42 patients (17%) underwent repeat T2EL intervention. Interventions included 44 translumbar sac embolizations, and transcatheter embolizations of nine IMAs and seven lumbar/hypogastric arteries. Aneurysm diameter was 6.1 ± 1.6 cm at EVAR, 6.6 ± 1.5 cm at initial T2EL treatment, and 6.9 ± 1.7 cm at last follow-up. There were no significant differences in the rates of aneurysm sac growth pre- and post-T2EL treatment. At last follow-up imaging, recurrent or persistent T2EL was noted in 72% of patients. Of 42 patients, nine (21%) received operative endoluminal correction of occult type I or type III endoleaks that were diagnosed during the T2EL angiographic intervention. There were no aneurysm ruptures or ARMs during follow-up; overall mortality for the 5-year study period was 24%. In this series, percutaneous endovascular intervention for type II endoleak with aneurysm sac growth does not appear to alter the rate of aneurysm sac growth, and the majority of patients display persistent/recurrent endoleak. However, diagnostic angiographic evaluation may reveal unexpected type I and III endoleaks and is therefore recommended for all patients with T2EL and sac growth. While coil and glue embolization of aneurysm sac and selected branch vessels does not appear to yield benefit in our series, the diagnosis and subsequent definitive treatment of previously occult type I and III endoleaks may explain the absence of delayed rupture and ARM in our series.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2012; 55(5):1263-7. · 3.52 Impact Factor
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    ABSTRACT: The purpose of this study was to analyze the trend in inpatient vascular procedures in the United States over the past decade and predict the future demand for vascular surgeons. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried to determine the weighted national estimates of inpatient vascular procedures performed on adult patients (age ≥ 18) between 1997 and 2008. Using population estimates from the United States Census Bureau, the per capita rates of inpatient procedures were calculated for age-specific groups (18-64 years, 65-84 years, and ≥ 85 years). The change in per capita rates over the past decade along with population forecasts were used to predict future workload. There was a net increase of 22% from 971,046 inpatient vascular procedures for all adults in 1997 to 1,188,332 in 2008. During the same time period, the adult population increased by 16% from 198 to 230 million. The age-stratified per capita rates of all vascular procedures were +21% for age 18 to 64; -4% for age 65 to 84; and +18% for age ≥ 85. This resulted in a net increase of 5% (490 to 515 procedures per 100,000 capita) in the per capita rate for all adults. Based on the assumption that trends in age-specific rates remain constant, there is a predicted inpatient workload increase (compared to 2008) of 18% by 2015, 34% by 2020, and 72% by 2030. The vascular workload is predicted to more than double by the year 2040. Despite a conservative approach of using a population-based analysis of only inpatient procedures, there is a dramatic increase in the predicted vascular workload for the future. The vascular surgery training process will need to adapt to ensure an adequate number of fellowship-trained vascular surgeons is available to provide quality vascular care in the future.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 01/2012; 55(5):1394-9; discussion 1399-400. · 3.52 Impact Factor
  • Jeffrey Jim, Brian G Rubin, Luis A Sanchez
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    ABSTRACT: The purpose of this study was to describe the use of a bifurcated endovascular graft to treat endograft migration with major endoleaks. We present four patients who presented at a mean of 72.0 months after their initial endovascular abdominal aortic aneurysm repair. Three patients had type I endoleaks resulting from proximal attachment failure and graft migration. A fourth patient had separation of a proximal aortic cuff from a migrated main body device resulting in a type III endoleak. All were treated with a bifurcated Zenith (Cook Medical Incorporated, Bloomington, IN, USA) endovascular graft. There was 100% technical success with no perioperative complications. On follow-up, one patient died of unrelated causes at five months. The mean survival for the remaining three patients was 37 months. In conclusion, treatment with a bifurcated Zenith endograft has advantages over the use of an aortic cuff or aortouniiliac reconstruction. To perform this technique, there must be a sufficient distance between the proximal landing zone and the flow divider of the migrated endograft to allow for deployment of the Zenith device. While there remain limitations in its applicability, the use of a bifurcated endovascular graft is a viable alternative for endovascular salvage in treatment of endograft migration with major endoleaks.
    Vascular 11/2011; 20(1):49-53. · 0.86 Impact Factor
  • Journal of Vascular Surgery. 11/2011; 54(5):1543.
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    ABSTRACT: The risks of developing sinistral portal hypertension as a result of occlusion of the splenic vein close to its termination during a Whipple procedure are unclear. Our purpose was to compare the pattern of venous collateral development after splenic vein ligation in an extended Whipple procedure with the pattern of collateral development in cases of sinistral portal hypertension. Five patients underwent an extended Whipple procedure in which the splenic vein was divided and not reconstructed. Six to eight months later detailed mapping of venous return from the spleen was determined by contrast-enhanced multidetector computed tomography or in one case by 3D contrast-enhanced MRI. Spleen size and length of residual patent splenic vein were also measured. The literature on sinistral portal hypertension was evaluated to ascertain whether the venous collateral pattern in cases of left-sided portal hypertension was similar to the pattern that developed when the splenic vein was ligated at its termination in the Whipple procedure. A length of splenic vein remained patent in all five patients, measuring 4.5 to 11.5 cm from the spleen. Splenomegaly did not develop. Blood returned from the spleen by multiple collaterals including collaterals in the omentum and mesocolon. These types of collaterals do not develop in sinistral portal hypertension, nor is residual patent splenic vein seen. Ligation of the splenic vein close to its termination in five patients resulted in a pattern of venous return different from patients that have developed left-sided portal hypertension.
    Journal of Gastrointestinal Surgery 09/2011; 15(11):2070-9. · 2.36 Impact Factor
  • Gustavo S Oderich, Mark A Farber, Luis A Sanchez
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    ABSTRACT: Anatomical constraints limit the utility of endovascular therapy with infrarenal stent grafts in approximately 40% of the patients. Fenestrated and branched stent grafts that incorporate the visceral and renal arteries are currently not approved for commercial use in the United States and require at least 6 to 8 weeks for customization. These devices are not currently available as an "off-the-shelf" option to treat complex aneurysms, although recent publications suggest that standardization will be possible in 70% to 80% of patients. Modification of aortic stent grafts with creation of reinforced fenestrations or side branches has been reported and may have a future role in the compassionate treatment of high-risk patients with complex aneurysms who otherwise would not have access to a manufactured device, or for those in need of urgent or emergent repair as in the case of a patient with an impending or contained ruptured aneurysm. This article summarizes the current principles applied for device design, procedure planning, and potential applications of modified stent grafts for urgent treatment of symptomatic or contained ruptured aortic aneurysms.
    Perspectives in Vascular Surgery 08/2011; 23(3):186-94.
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    ABSTRACT: Fond Le traitement ouvert traditionnel des anévrysmes aortiques de l'arche distal exige une procédure en deux temps associée à une morbidité et à une mortalité significative. L'introduction du traitement endovasculaire des anévrysmes thoraciques représente une option moins invasive pour accomplir le second temps du traitement après création proximale de la trompe d'éléphant. Cette étude présente une série de patients traités par technique hybride proximale ouverte et distale endovasculaire des anévrysmes aortiques de l'arche distal. Méthodes Une revue rétrospective a été réalisée dans un centre médical universitaire. Tous les patients traités par technique hybride étaient identifiés. Les patients étaient évalués selon leurs données démographiques, l'imagerie préopératoire, le succès technique, les complications postopératoires, la longueur du séjour hospitalier, le recours à une intervention secondaire, et la survie globale. Résultats Un total de 10 patients (3 hommes, âge moyen : 67,5 ans) a été identifié au cours d'une période de quatre ans entre août 2005 et juillet 2009. Tous les patients étaient traités de façon élective et le diamètre maximum moyen de l'anévrysme était de 70,8 mm. Sur les 10 patients, quatre avaient subi une thoracotomie précédente (trois traitements aortiques, une résection pulmonaire pour lésion maligne) et tous étaient considérés à risque élevé pour la chirurgie ouverte du deuxième temps. Les trois premiers patients ont été traités avec une intervention endovasculaire secondaire par accès artériel rétrograde. Les sept patients plus récents ont subi un traitement en un seul temps avec pose de l'endoprothèse par un accès aortique ascendant antérograde. Le succès technique a été obtenu dans tous les cas. Aucune paraplégie ou accident vasculaire cérébral periopératoire n'a été rapporté. Un patient a été traité avec succès de façon endovasculaire d'une endofuite de type IB à 38 mois. Un autre a présenté un élargissement de son anévrysme thoraco-abdominal entrainant une endofuite de type IB qui a été détecté à 43 mois. Il y avait un décès dans les 30 jours postopératoires. Les neuf autres patients sont tous vivants, avec une survie moyenne de 35,1 mois (extrêmes: 8-53) après la chirurgie. Conclusions L'approche hybride du traitement des anévrysmes aortiques de l'arche distal est sûre et représente une d'alternative à la chirurgie ouverte conventionnelle. Son caractère moins invasif techniquement, le fait d'éviter un deuxième temps chirurgical et d'éliminer le risque de perte de suivi, ou de mortalité dans l'intervalle, nous ont menés à préférer le traitement en une seule étape en utilisant un abord antérograde.
    Annales de Chirurgie Vasculaire. 07/2011; 25(5):641–647.
  • Francis J Caputo, Jeffrey Jim, Luis A Sanchez
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    ABSTRACT: An 86-year-old female was incidentally discovered with an asymptomatic 5.3 cm infrarenal aortic aneurysm. Preoperative imaging demonstrated the aortic neck to have severe suprarenal and infrarenal angulation. The patient was deemed unfit for open aortic repair due to multiple medical comorbidities. Endovascular treatment was performed with a modified Zenith bifurcated graft using a Zenith TX2 endograft as a proximal aortic cuff. There were no perioperative complications, and postoperative imaging demonstrated aneurysm exclusion with no migration or major endoleaks. The patient died of unrelated causes at 21 months. The use of a thoracic endograft as a proximal cuff is an alternative technique in the endovascular treatment of abdominal aortic aneurysms with a severely angulated neck.
    Vascular and Endovascular Surgery 06/2011; 45(6):553-6. · 0.88 Impact Factor
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    ABSTRACT: The aim of the present paper is to evaluate the long-term outcomes of endovascular aneurysm repair (EVAR) for challenging aortic necks. Subgroup analyses were performed on 156 patients from the prospective multicenter Talent eLPS (enhanced Low Profile Stent Graft System) trial. Patients with high-risk aortic necks (length < 15 mm or diameter ≥28 mm) were compared with the remaining patients. Patients with high-risk (n = 86) and low-risk necks (n = 70) had similar age and gender distribution. Despite similar prevalences of co-morbidities, the high-risk group had higher Society for Vascular Surgery scores. The high-risk group also had larger maximum aneurysm diameters (56.6 versus 53.0 mm, P < 0.02). There were lower freedoms from major adverse events (MAEs) for the high-risk group at 30 days (84.9 versus 95.7%; P < 0.04) and 365 days (73.4 versus 89.2%; P = 0.02). Effectiveness endpoints at 12 m showed no significant differences. Freedom from all-cause mortality at 30 days (96.5 versus 100%) and aneurysm-related mortality at 365 days (96.0 versus 100%) were similar. At five years, there were no differences in endoleaks or change in aneurysm diameter. All migrations occurred in the high-risk group. The five-year freedom from aneurysm-related mortality for the high- and low-risk groups was 93.2 and 100%, respectively. In conclusion, despite a higher rate of MAEs within the first year and higher migration rates at five years, EVAR in aneurysms with challenging aortic necks can be treated with acceptable long-term results.
    Vascular 06/2011; 19(3):132-40. · 0.86 Impact Factor
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    ABSTRACT: To evaluate the outcomes of endovascular aneurysm repair (EVAR) in patients with small (≤5.4 cm) and large (≥5.5 cm) abdominal aortic aneurysms (AAAs). Data for this study were obtained from the prospective, nonrandomized, multicenter Talent enhanced Low Profile Stent trial that enrolled patients between February 2002 and April 2003. A total of 156 patients with adequate preoperative imaging were identified for this study. Subgroup analyses were performed for patients with small (≤5.4 cm) and large (≥5.5 cm) AAAs. Demographics, aneurysm morphology, and perioperative endpoints were assessed. Safety and effectiveness endpoints were evaluated at 30 days, 1 year, and 5 years postprocedure. Patients with small AAAs (n = 85) had similar age, gender, and medical risk profile compared with those for larger AAAs (n = 71). The proximal aortic necks in small AAAs were longer (24.7 mm vs. 20.7 mm, p = 0.05), less angulated (27.2° vs. 34.2°, p = 0.01), and smaller (24.6 mm vs. 26.1 mm, p = 0.01). Patients with small AAAs spent less time in intensive care (8.1 hour vs. 26.3 hour, p = 0.03); however, other perioperative endpoints were similar. Although the group with small AAAs had a statistically significant higher rate of successful aneurysm treatment (96.8% vs. 84.9%, p = 0.04), no difference was observed in all other effectiveness endpoints at 12 months. No differences in freedom from major adverse events at 30 days and 365 days were reported. At 5 years, no differences in rates of migration, endoleaks, change in aneurysm diameter, or freedom from aneurysm-related mortality were found. Further subgroup analyses segregating patients with very small (≤5.0 cm, n = 55), small (5.1-5.4 cm, n = 30), and larger (≥5.5 cm) AAAs also showed no statistically significant differences in postoperative outcomes. In a prospective clinical trial setting with long-term follow-up, patients with small (≤5.4 cm) AAAs had aortic neck characteristics which were more favorable for EVAR. Despite these anatomic differences, clinical outcomes were similar to patients with large AAAs. Thus, we conclude that EVAR for small AAA should not be routinely recommended for patients on the basis of the assumption of improved outcomes.
    Annals of Vascular Surgery 04/2011; 25(3):306-14. · 0.99 Impact Factor
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    ABSTRACT: Rationnelle Evaluer les résultats de la réparation endovasculaire des anévrysmes (EVAR) chez les patients présentant de petits (≤5,4 cm) et gros (≥5,5 cm) anévrysmes aortiques abdominaux (AAA). Méthode Les données de cette étude ont été obtenues à partir de l’étude prospective, non randomisée, multicentrique Talent enhanced Low Profile Stent qui a inclus des patients entre février 2002 et avril 2003. Un total de 156 patients avec une imagerie préopératoire adaptée ont été identifiés pour cette étude. Des analyses de sous-groupe ont été réalisées pour les patients avec petit (≤5,4 cm) et gros (≥5,5 cm) AAA. La démographie, la morphologie de l’anévrysme, et les critères d’évaluation péri opératoire ont été évalués. Des critères de sûreté et d’efficacité ont été évalués à 30 jours, à 1 an, et à 5 ans post procédure. Résultats Les patients avec petit AAA (n = 85) étaient comparables pour l’âge, le genre, et le profil médical de risque à ceux avec gros AAA (n = 71). Les collets aortiques proximaux des petits AAA étaient plus longs (24,7 millimètres contre 20,7 millimètres, p = 0,05), moins angulés (27,2° contre 34,2°, p = 0,01), et plus petits (24,6 millimètres contre 26,1 millimètres, p = 0,01). Les patients avec petits AAA ont passé moins de temps en soins intensifs (8,1 heures contre 26,3 heures, p = 0,03); cependant, d’autres critères d’évaluation péri opératoires étaient semblables. Bien que le groupe avec petit AAA ait eu un taux plus élevé statistiquement significatif de traitement réussi de l’anévrysme (96,8% contre 84,9%, p = 0,04), on n’a observé aucune différence pour tous les autres critères d’évaluation d’efficacité à 12 mois. Aucune différence dans l’absence des événements défavorables importants à 30 jours et à 365 jours n’a été rapportée. À 5 ans, aucune différence dans les taux de migration, d’endofuite, de changement de diamètre d’anévrysme, ou d’absence de mortalité liée anévrysme n’ont été trouvés. D’autres analyses de sous-groupes séparant les patients avec très petit (≤5,0 cm, n = 55), petit (5,1-5,4 cm, n = 30), et gros (≥5,5 cm) AAA n’ont montré de différence statistiquement significative concernant les résultats postopératoires. Conclusions Dans une étude prospective randomisée avec suivi à long terme, les patients avec petit (≤5,4 cm) AAA avaient des caractéristiques de collets aortiques qui étaient plus favorables pour l’EVAR. En dépit de ces différences anatomiques, les résultats cliniques étaient semblables aux patients avec gros AAA. Ainsi, nous concluons que l’EVAR pour les petits AAA ne devrait pas être recommandé par habitude pour des patients sur la base du credo de résultats améliorés.
    Annales de Chirurgie Vasculaire. 04/2011; 25(3):330–339.
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    ABSTRACT: The Zenith Renu abdominal aortic aneurysm (AAA) Ancillary Graft (Cook Medical Inc, Bloomington, Ind) provides active proximal fixation for treatment of pre-existing endografts with failed or failing proximal fixation or seal. The purpose of this study was to evaluate the midterm outcomes of treatment with this device. From September 2005 to November 2006, a prospective, nonrandomized, multicenter, postmarket registry was utilized to collect physician experiences from 151 cases (89 converters and 62 main body extensions) at 95 institutions. Preoperative indications and procedural and postimplantation outcomes were collected and analyzed. Technical success and clinical success were determined as defined by the Society of Vascular Surgery reporting standards. Patients were predominantly male (87%) with a mean age of 77 years. The interval between the original endograft implantation to Renu treatment was 43.4 ± 18.7 months. The indications for treatment were endoleak (n = 111), migration (n = 136), or both (n = 94). Technical success was 98.0% with two cases of intraoperative conversion and one case of persistent type IA endoleak. The median follow-up for the cohort was 45.0 months (range, 0-56 months; interquartile range, 25.0 months). Overall, 32 cases had treatment failures that included at least one of the following: death (n = 5), type I/III endoleak (n = 18), graft infection (n = 1), thrombosis (n = 1), aneurysm enlargement >5 mm (n = 9), rupture (n = 4), conversion (n = 9, with 7 after 30 days), and migration (n = 1). Overall, the clinical success for the entire cohort during the follow-up period was 78.8% (119/151). The postmarket registry data confirm that the Zenith Renu AAA Ancillary Graft can be used to treat endovascular repairs that failed due to proximal attachment failures. The salvage treatment with the Renu device had high technical success rate and resulted in clinical success in a majority of patients (78.8%). While failed endovascular repairs can be salvaged, a clinical failure in one of five patients still emphasizes the importance of patient and device selection during initial endovascular aneurysm repair to ensure durable success.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2011; 54(2):307-315.e1. · 3.52 Impact Factor
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    ABSTRACT: We report a patient who presented with transient cortical blindness 12 hours after completion of a thoracic endovascular aneurysm repair. Computed tomography of the brain demonstrated no acute findings. The patient's symptoms resolved spontaneously after 72 hours. To our knowledge, this is the first report of transient cortical blindness after endovascular aortic aneurysm repair. This is an uncommon diagnosis that is important to recognize in a modern vascular surgery practice.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 01/2011; 53(5):1405-8. · 3.52 Impact Factor
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    Journal of Vascular Surgery - J VASC SURG. 01/2011; 53(6).
  • Journal of Vascular Surgery - J VASC SURG. 01/2011; 53(6).

Publication Stats

689 Citations
128.89 Total Impact Points

Institutions

  • 2002–2014
    • Washington University in St. Louis
      • Department of Surgery
      San Luis, Missouri, United States
  • 2002–2012
    • University of Washington Seattle
      • • Division of Vascular Surgery
      • • Department of Surgery
      Seattle, WA, United States
  • 2011
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
  • 2002–2010
    • Barnes Jewish Hospital
      San Luis, Missouri, United States
  • 2008
    • Emory University
      • Department of Surgery
      Atlanta, GA, United States
  • 2006
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 2003
    • University of South Florida
      • Division of Vascular and Endovascular Surgery
      Tampa, FL, United States