Document Detail


Open surgical treatment of aneurysmal sac expansion following endovascular abdominal aneurysm repair: solution for an unresolved clinical dilemma.
MedLine Citation:
PMID:  17714635     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The advantages of endovascular aneurysm repair (EVAR) are probably related to the avoidance of the three major physiological insults associated with open abdominal aortic aneurysm (AAA) repair: laparotomy, aortic cross-clamping and ischemia reperfusion injury. Continuing aneurysm expansion indicates a failure to exclude the AAA from the circulation. We describe our experience with open surgery of post-EVAR sac expansion. A consecutive series of 68 EVAR patients was followed up. Endovascular and minimally invasive procedures were the initial treatment option. Failure of these attempts to curtail AAA sac expansion or type 2 large endoleaks (EL) resulted in opening of the aneurysm sac. The procedure includes positioning of a deflated occlusion balloon proximal to the stent graft (SG). Laparotomy with opening of the eneurysm sac was then performed. The thrombus was removed and backbleeding vessels oversewn. The aneurysm sac was then plicated over the SG. Four patients (5.9%) were diagnosed as having either persistent large type 2 EL or sac enlargement. In all patients the procedure was accomplished successfully. One patient died from acute myocardial infarction perioperatively. Three patients recovered uneventfully and follow-up computed tomography confirmed the absence of endoleak and a disappearance of the AAA. We believe that whenever EVAR fails to exclude the aneurysm from the circulation, open exploration without graft replacement should be considered.
Authors:
Moshe Halak; Ciaran O McDonnell; Mark D Muhlmann; Stephen R Baker
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Vascular     Volume:  15     ISSN:  1708-5381     ISO Abbreviation:  Vascular     Publication Date:    2007 Jul-Aug
Date Detail:
Created Date:  2007-08-23     Completed Date:  2008-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101196722     Medline TA:  Vascular     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  201-4     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia. shalak@bigpond.net.au
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis Implantation / methods*
Female
Humans
Male
Middle Aged
Prospective Studies
Reoperation / methods
Stents
Surgical Procedures, Minimally Invasive*
Treatment Failure
Treatment Outcome

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


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