Document Detail


Middle-term results of endovascular aneurysm repair in Japan: does intraoperative endovascular management against the hostile aneu-rysmal neck prevent the proximal type I endoleak?
MedLine Citation:
PMID:  21804487     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
AIM: Endovascular aneurysm repair (EVAR) was first approved in Japan in 2007. In order to avoid the learning curve generally seen in the initial stages of implementation, we have aimed for procedural perfection. As the proximal type I endoleak (EL) is associated with a higher risk of late conversion and rupture, so we have treated the intraoperative type I EL scrupulously. The hostile neck, which is known to be a risk for perigraft leakage, is the focus of this study. We showed both the middle-term results of EVAR in our country and the possible necessity of intraoperative management for the hostile neck.
METHODS: From a consecutive series of 134 patients who underwent EVAR of abdominal aortic aneurysms, 129 cases in which contrast agent was used intraoperatively were selected. All cases had at least 12-month follow-up postoperatively (12-40 months). Of the 129 selected cases, 49 cases (37%) that did not fulfill the commercially recommended criteria of the aneurysmal neck (length <15 mm and angle >60° of the aneurysm or >45° of the suprarenal aorta) were assigned to the off-label group. The other 80 cases were assigned to the on-label group. We carefully observed the completion angiography and when we found or suspected a type I EL, we performed a re-touch up, changed to a non-compliant balloon, and used a supportive device, such as a PalmazTM stent or aortic cuffs, in sequence.
RESULTS: No postoperative type I ELs were detected within the follow-up period. Intraoperative type I ELs were detected more frequently in the off-label group (51%) than the on-label group (20%) (P<0.01). The rate of type I EL in the off-label group in terms of the neck length criteria (11/14 cases) was higher than that in the on-label group (30/115 cases) (P<0.01). In terms of the neck angle, patients in the off-label group had a greater tendency to develop the type I EL than those in the on-label group (18/42 vs. 23/87 cases) (P=0.06).
CONCLUSION: Off-label usage regarding aneurysmal neck length and angle tends to be incomplete without additional procedures. Conversely, various techniques, including non-compliant balloon usage and aortic stenting or cuffs, produce good results for the intraoperative type I EL. We found a relationship between the neck condition and the intraoperative type I EL, and showed the importance of strictly obeying our simple algorithm against the proximal type I EL.
Authors:
K Hoshina; M Kato; A Hosaka; T Miyahara; A Mikuriya; N Ohkubo; T Miyata
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International angiology : a journal of the International Union of Angiology     Volume:  30     ISSN:  1827-1839     ISO Abbreviation:  Int Angiol     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-08-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8402693     Medline TA:  Int Angiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  467-73     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, the University of Tokyo Hospital, Tokyo, Japan - hoshinak-sur@h.u-tokyo.ac.jp.
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