Document Detail


Technical considerations for late removal of aortic endografts.
MedLine Citation:
PMID:  12368724     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The endovascular repair of abdominal aortic aneurysms has become increasingly common during the past decade. Despite aggressive attempts to treat endoleak and graft failure with endovascular salvage procedures, some grafts necessitate surgical removal. We reviewed our experience with late endograft explantation in an effort to identify technical maneuvers critical for success.
METHODS: Of 110 patients treated with aortic abdominal endografts at the University of Rochester Medical Center between August 1997 and June 2001, five (4.5%) needed late graft removal. Medical records, radiographic files, and case report forms were retrospectively reviewed.
RESULTS: One Talent (Medtronic AVE, Santa Rosa, Calif) and four Vanguard (Boston Scientific, Natick, Mass) grafts were removed at a mean of 32.7 months (range, 18 to 44 months) after implantation. One patient underwent conversion for rupture, three for endoleaks (one each with types I, II, and III), and one for stent separation from the graft material without endoleak or aneurysm expansion. Three cases were approached via the midline, one through a bilateral subcostal incision, and one through a retroperitoneal incision. Supraceliac aortic control was used in all patients. Removal of two of the Vanguard grafts necessitated extension of the aortotomy above the level of the renal orifices. One perioperative death occurred. The mean operative blood loss was 4700 mL (range, 1850 to 9000 mL), and length of stay was 19.8 days (range, 7 to 42 days).
CONCLUSION: The morbidity and mortality rates associated with late removal of endografts are significant. Removal of Vanguard devices can necessitate extension of the aortotomy above the renal arteries. We believe that control of the aorta well above the proximal fixation site is the key to removal and that continuous aortic exposure via retroperitoneal exposure is the best option in this situation.
Authors:
Sean P Lyden; JoAnne M McNamara; Yaron Sternbach; Karl A Illig; David L Waldman; Richard M Green
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  36     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-07     Completed Date:  2002-11-04     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  674-8     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Lydens@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality,  surgery*
Blood Vessel Prosthesis / adverse effects*
Device Removal / adverse effects*,  mortality
Equipment Failure
Humans
Intraoperative Complications*
Male
Middle Aged
Retrospective Studies
Time Factors

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


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