Document Detail


Aneurysm sac "thrombization" and stabilization in EVAR: a technique to reduce the risk of type II endoleak.
MedLine Citation:
PMID:  20681769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate the reduction in type II endoleak risk after introducing a new prevention method, "thrombization" or clotting of the aneurysm sac, during endovascular aneurysm repair (EVAR) versus the standard EVAR technique.
METHODS: From September 1999 to December 2008, 469 consecutive patients underwent EVAR for AAA at our institution. In 2003, the injection of fibrin glue with or without microcoils into the aneurysm sac was added to the EVAR treatment plan ("thrombization" technique). Patients who did not meet the inclusion criterion (at least 1-year follow-up imaging) were censored at the end of 2007, leaving 404 patients eligible for the study: 224 patients (210 men; mean age 71.9+/-8.5 years, range 25-88) undergoing EVAR alone from September 1999 to May 2003 (group 1) compared to 180 patients (161 men; mean age 72.6+/-8 years, range 46-89) who underwent EVAR + thrombization from June 2003 to December 2006 (group 2).
RESULTS: The 2 treatment groups were similar with regard to aneurysm morphology. No allergic or anaphylactic reactions were encountered related to the fibrin glue. Over median follow-up times of 72 months in group 1 and 26 months in group 2, there were 34 (15.2%) endoleaks in group 1 versus 4 (2.2%) in group 2 (p<0.0001). The incidence of type II endoleak was 0.25/100 person-months for group 1 versus 0.07/100 person-months for group 2. The preventive sac thrombization technique was significantly associated with a reduced risk of type II endoleak (HR 0.13, 95% CI 0.05 to 0.36; p<0.0001) regardless of the type of stent-graft fixation (infrarenal versus suprarenal).
CONCLUSION: The preventive method of intrasac "thrombization" using fibrin glue injection with or without the insertion of coils proves to be a simple, low cost, safe, and effective technique to significantly reduce the risk of type II endoleaks irrespective of the endograft used.
Authors:
Salvatore Ronsivalle; Francesca Faresin; Francesca Franz; Carlo Rettore; Mario Zanchetta; Armando Olivieri
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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 Aug 
Date Detail:
Created Date:  2010-08-04     Completed Date:  2010-11-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  517-24     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Disease-Vascular and Endovascular Surgery and Angiology, Cittadella Hospital, Cittadella, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / radiography,  surgery,  therapy*
Aortography / methods
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Combined Modality Therapy
Embolization, Therapeutic* / instrumentation
Female
Fibrin Tissue Adhesive / administration & dosage*
Humans
Injections, Intralesional
Italy
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Prosthesis Design
Prosthesis Failure
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrin Tissue Adhesive
Comments/Corrections
Comment In:
J Endovasc Ther. 2010 Aug;17(4):525-6   [PMID:  20681770 ]

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


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