Ali Kordzadeh1, Tamer Sayed1, Manfred J Ramirez1, Ioannis Prionidis1, Adam Howard2, Tom Browne1. 1. Department of Vascular and Endovascular Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom. 2. East Suffolk & North Essex NHS Foundation Trust, Colchester General Hospital, Tumer Road, Colchester, Essex, C04 5JL, United Kingdom.
Abstract
Objective: Refractory type 1a endoleak after endovascular aneurysm repair (EVAR) can pose a significant challenge to surgeons and interventional radiologists. Continuous sac expansion results in aneurysm rupture and mortality. In such circumstances, an external infrarenal aortic wrap could serve as an essential and alternative solution. Methods: We assessed the application of an infrarenal aortic neck wrap for the treatment of refractory type 1a endoleak in n=6 consecutive patients along with the introduction of a novel assessment technique in order to assure their intraoperative success with no radiation exposure and contrast use. Results: The median sac expansion was 8.5 mm (interquartile range [IQR], 5-20 mm). The median neck diameter and length of the aortic neck were 23 mm (IQR, 18-25 mm) and 21 mm (IQR, 18-25 mm), respectively. The median length of follow-up post wrap is 24 months (IQR, 14-34 months). There was no associated mortality or morbidity and requirement for any further interventions. Conclusion: The study demonstrates that aortic wrapping for the treatment of refractory type 1a endoleak for any given neck diameter and length is safe, effective, and long lasting. The suggested novel intraoperative assessment technique contributes to the safety of the procedure by diminishing the need for intraoperative radiation exposure, contrast, and shorter operative time.
Objective: Refractory type 1a endoleak after endovascular aneurysm repair (EVAR) can pose a significant challenge to surgeons and interventional radiologists. Continuous sac expansion results in aneurysm rupture and mortality. In such circumstances, an external infrarenal aortic wrap could serve as an essential and alternative solution. Methods: We assessed the application of an infrarenal aortic neck wrap for the treatment of refractory type 1a endoleak in n=6 consecutive patients along with the introduction of a novel assessment technique in order to assure their intraoperative success with no radiation exposure and contrast use. Results: The median sac expansion was 8.5 mm (interquartile range [IQR], 5-20 mm). The median neck diameter and length of the aortic neck were 23 mm (IQR, 18-25 mm) and 21 mm (IQR, 18-25 mm), respectively. The median length of follow-up post wrap is 24 months (IQR, 14-34 months). There was no associated mortality or morbidity and requirement for any further interventions. Conclusion: The study demonstrates that aortic wrapping for the treatment of refractory type 1a endoleak for any given neck diameter and length is safe, effective, and long lasting. The suggested novel intraoperative assessment technique contributes to the safety of the procedure by diminishing the need for intraoperative radiation exposure, contrast, and shorter operative time.
Authors: Elliot L Chaikof; Jan D Blankensteijn; Peter L Harris; Geoffrey H White; Christopher K Zarins; Victor M Bernhard; Jon S Matsumura; James May; Frank J Veith; Mark F Fillinger; Robert B Rutherford; K Craig Kent Journal: J Vasc Surg Date: 2002-05 Impact factor: 4.268
Authors: T A Chuter; R M Faruqi; R Sawhney; L M Reilly; R B Kerlan; C J Canto; G C Lukaszewicz; J M Laberge; M W Wilson; R L Gordon; S D Wall; J Rapp; L M Messina Journal: J Vasc Surg Date: 2001-07 Impact factor: 4.268
Authors: J May; G H White; R Waugh; P Petrasek; X Chaufour; M Arulchelvam; M S Stephen; J P Harris Journal: Eur J Vasc Endovasc Surg Date: 2000-06 Impact factor: 7.069