Document Detail


Adjunctive iliac stents reduce the risk of stent-graft limb occlusion following endovascular aneurysm repair with the Zenith stent-graft.
MedLine Citation:
PMID:  20199276     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine whether the introduction of a policy of adjunctive stent insertion based on preoperative CT assessment or completion angiography reduced the incidence of limb occlusion after stent-graft implantation for endovascular aneurysm repair (EVAR). METHODS: A tertiary referral unit's endovascular database was retrospectively interrogated to compare the incidence of endograft limb occlusion in Zenith grafts following the introduction of a policy of selective adjunctive stent insertion. Group A included 288 limbs at risk in 146 patients (134 men; mean age 74+/-8 years) treated prior to August 2005 in whom adjunctive stents were inserted on an ad hoc basis only. Group B included 293 limbs at risk in 149 patients (127 men; mean age 76+/-7 years) treated after this date in whom a more aggressive adjunctive stenting strategy was adopted. Kaplan-Meier analysis was employed to compare outcomes. RESULTS: In total, 295 patients underwent EVAR involving 581 iliac vessels, of which 11 (1.8%) occluded at a median of 24 months (0-27). Of 65 limbs extended into the external iliac segment, 5 (7.6%) subsequently occluded; in the remaining 516 limbs, there were 6 (1.1%) occlusions (p = 0.004). Across the study group, 38 (6.5%) adjunctive stents were deployed in limbs deemed at risk; 1 (2.6%) of these occluded. In the remaining 543 unstented limbs, 10 (1.8%) occlusions occurred (p = 0.15). There were 11 occlusions in group A, in which 5 (1.7%) adjunctive stents had been deployed, but none in group B, which had received 33 (11.2%) stents (p<0.0001). Kaplan-Meier survival curves identified primary patency rates at 36 months of 96% and 100%, respectively (p = 0.001). CONCLUSION: Adjunctive stenting significantly reduces the risk of postoperative stent-graft limb occlusion without obvious compromise to the aneurysm repair.
Authors:
Olufemi A Oshin; Robert K Fisher; Leith A Williams; John A Brennan; Geoffrey L Gilling-Smith; S Rao Vallabhaneni; Richard G McWilliams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  17     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-03-04     Completed Date:  2010-05-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  108-14     Citation Subset:  IM    
Affiliation:
Regional Vascular Unit and, Royal Liverpool University Hospital, Liverpool L7 8XP, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Chi-Square Distribution
Female
Graft Occlusion, Vascular / etiology,  prevention & control*
Humans
Iliac Artery / radiography,  surgery*
Kaplan-Meiers Estimate
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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