<ul><li>DR IMRAN JAVED, </li></ul><ul><li>MBBS, FCPS Surgery. </li></ul><ul><li>INTERNATIONAL FELLOW </li></ul>JOURNAL CLU...
Long-term Follow-up of Secondary Interventions After Endovascular Aneurysm Repair With the AneuRx Endoprosthesis:  A Singl...
Department of Vascular Surgery  St. Antonius Hospital, Nieuwegein, and, University Medical Center Utrecht, The Netherlands...
AIM OF THE STUDY <ul><li>To report short and long-term results of secondary interventions, including renewed endo-vascular...
Methods <ul><li>Between 1996 and 2003, an AneuRx device was used primarily in 212 patients (197 men; mean age 71±7.0 years...
DEMOGRAPHICS OF 62 PATIENTS 15 (24%) COPD 6 (10 %) HISTORY OF STROKE 25 (40%) HISTORY OF M.I. 1 (2%) HYPERHOMOCYSTEINEMIA ...
Complications after EVAR AneuRx EVAR (n=212) Type Ia (n=28) Type Ib (n=6) Type II (n=8) Type III (n=17) Obstruction (n=3) ...
MANAGEMENT OF TYPE I ENDOLEAK Type Ia= 28 Cuff=23 Aorto-monoiliac graft =4 Open=1 Type Ib=6 Cuff =6
MANAGEMENT OF TYPE II & III ENDOLEAK Type III=17 Cuff=9 Aorto-monoiliac  Graft=7 Open=1 Type II Embolization=8
ENDOGRAFT OBSTRUCTION <ul><li>LYSIS </li></ul><ul><li>(n=1) </li></ul><ul><li>OPEN </li></ul><ul><li>(n=2) </li></ul>
INDICATIONS FOR EVAR <ul><li>Infra-renal AAA >5.5 cm. </li></ul><ul><li>Isolated Iliac Artery Aneurysm >3.5cm. </li></ul><...
FOLLOW-UP PATIENTS <ul><li>BY CT-ANGIOGRAPHY (CTA) </li></ul><ul><li>1- BEFORE DISCHARGE. </li></ul><ul><li>2- AT 3 MONTHS...
DEFINITIONS <ul><li>TECHNICAL SUCCESS is defined as successful access to the arterial system using a remote site; successf...
OUTCOME OF SECONDARY INTERVENTION 42 (68%) 59 (95%) TOTAL=62 0 (0%) 0 (0%) 1 (100%) 2 (100%) OBSTRUCTION=3 LYSIS=1 OPEN RE...
Results <ul><li>Of the 212 AneuRx patients, 59 (28%) required secondary interventions for endoleaks (28 type Ia, 6 type Ib...
Results <ul><li>Overall 30-day morbidity after a secondary intervention was 18% (11/62); the 30-day mortality was 5% (3/62...
<ul><li>Patients with a primary AneuRx stent-graft had an acceptable yearly risk of requiring a secondary intervention fol...
 
Upcoming SlideShare
Loading in …5
×

july 2010 jc

908 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
908
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
12
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

july 2010 jc

  1. 2. <ul><li>DR IMRAN JAVED, </li></ul><ul><li>MBBS, FCPS Surgery. </li></ul><ul><li>INTERNATIONAL FELLOW </li></ul>JOURNAL CLUB July 2010
  2. 3. Long-term Follow-up of Secondary Interventions After Endovascular Aneurysm Repair With the AneuRx Endoprosthesis: A Single-Center Experience
  3. 4. Department of Vascular Surgery St. Antonius Hospital, Nieuwegein, and, University Medical Center Utrecht, The Netherlands . <ul><li>Guus W. van Lammeren, MD, </li></ul><ul><li>Bram Fioole, MD, PhD, </li></ul><ul><li>Evert J. Waasdorp, MD, </li></ul><ul><li>Frans L. Moll, MD, PhD, </li></ul><ul><li>Joost A. van Herwaarden, MD, PhD </li></ul><ul><li>Jean-Paul P. M. de Vries, MD, PhD </li></ul>
  4. 5. AIM OF THE STUDY <ul><li>To report short and long-term results of secondary interventions, including renewed endo-vascular and open reconstructions, occuring in a single center cohort of EVAR patients treated with an AneuRx stent-graft endoprosthesis. </li></ul>
  5. 6. Methods <ul><li>Between 1996 and 2003, an AneuRx device was used primarily in 212 patients (197 men; mean age 71±7.0 years). </li></ul><ul><li>Sixty-two (29%) patients (58 men; mean age 73±7.2 years) required a secondary intervention (percutaneous, endovascular, or open repair) after EVAR and were prospectively followed after their secondary interventions. </li></ul><ul><li>Data were analyzed retrospectively. </li></ul>
  6. 7. DEMOGRAPHICS OF 62 PATIENTS 15 (24%) COPD 6 (10 %) HISTORY OF STROKE 25 (40%) HISTORY OF M.I. 1 (2%) HYPERHOMOCYSTEINEMIA 19 (31%) HYPERCHOLESTROLEMIA 2 (3%) DIABTES MELLITUS 19 (31%) HYPERTENSION 58 (95%) MEN 73+-7.2 AGE (YEARS)
  7. 8. Complications after EVAR AneuRx EVAR (n=212) Type Ia (n=28) Type Ib (n=6) Type II (n=8) Type III (n=17) Obstruction (n=3) Secondary intervention (n=62) No secondary Intervention (n=150)
  8. 9. MANAGEMENT OF TYPE I ENDOLEAK Type Ia= 28 Cuff=23 Aorto-monoiliac graft =4 Open=1 Type Ib=6 Cuff =6
  9. 10. MANAGEMENT OF TYPE II & III ENDOLEAK Type III=17 Cuff=9 Aorto-monoiliac Graft=7 Open=1 Type II Embolization=8
  10. 11. ENDOGRAFT OBSTRUCTION <ul><li>LYSIS </li></ul><ul><li>(n=1) </li></ul><ul><li>OPEN </li></ul><ul><li>(n=2) </li></ul>
  11. 12. INDICATIONS FOR EVAR <ul><li>Infra-renal AAA >5.5 cm. </li></ul><ul><li>Isolated Iliac Artery Aneurysm >3.5cm. </li></ul><ul><li>Combined Aorto-iliac anerysmal disease. </li></ul>
  12. 13. FOLLOW-UP PATIENTS <ul><li>BY CT-ANGIOGRAPHY (CTA) </li></ul><ul><li>1- BEFORE DISCHARGE. </li></ul><ul><li>2- AT 3 MONTHS. </li></ul><ul><li>3- AT 12 MONTHS. </li></ul><ul><li>4- THEN YEARLY CTA. </li></ul>
  13. 14. DEFINITIONS <ul><li>TECHNICAL SUCCESS is defined as successful access to the arterial system using a remote site; successful deployment of graft, with secure proximal & distal fixation and no Type I or Type III endoleak; and a patent graft without significant twist, kinks, or obstruction. </li></ul><ul><li>CLINICAL SUCCESS is defined as successful deployment of endovascular device at the intended location with death as a results of aneurysm-related treatment, Type I or Type III endoleak, graft infection or thrombosis, aneurysm expansion (5mm diameter or 5% volume), aneurysm rupture or conversion to open repair. </li></ul>
  14. 15. OUTCOME OF SECONDARY INTERVENTION 42 (68%) 59 (95%) TOTAL=62 0 (0%) 0 (0%) 1 (100%) 2 (100%) OBSTRUCTION=3 LYSIS=1 OPEN REPAIR=2 6 (67%) 6 (86%) 1 (100%) 9 (100%) 7 (100%) 1 (100%) TYPE III=17 INTERPOSITION CUFF=9 AOERTOMONOILIAC GRAFT=7 OPEN REPAIR=1 7 (88%) 7 (88%) TYPE II=8 EMBOLIZATION 6 (100%) 5 (83%) TYPE Ib=6 EXTENSION CUFF=6 12 (52%) 3 (75%) 1 (100%) 22 (96%) 4 (100%) 1 (100%) TYPE Ia=28 EXTENSION CUFF=23 AORTOMONOILIAC GRAFT=4 OPEN REPAIR=1 CLINICAL SUCCESS TECHNICAL SUCCESS INDICATION
  15. 16. Results <ul><li>Of the 212 AneuRx patients, 59 (28%) required secondary interventions for endoleaks (28 type Ia, 6 type Ib, 8 type II, and 17 type III) and 3 (1%) for obstruction of the endoprosthesis. </li></ul><ul><li>The mean interval between primary EVAR and secondary intervention was 39±30 months. </li></ul><ul><li>The yearly risk of requiring a secondary intervention after receiving a primary AneuRx graft was 3.7%. </li></ul>
  16. 17. Results <ul><li>Overall 30-day morbidity after a secondary intervention was 18% (11/62); the 30-day mortality was 5% (3/62). Short endovascular extender cuffs were used for type Ia endoleaks in 23 of 28 patients. </li></ul><ul><li>Over a mean follow-up of 81±34 months after the secondary intervention, the success of short endovascular cuffs for treatment of type Ia endoleak was 52% (12/23); the remaining 11 (48%) patients required additional reinterventions for recurrent endoleak or persistent aneurysm growth. </li></ul>
  17. 18. <ul><li>Patients with a primary AneuRx stent-graft had an acceptable yearly risk of requiring a secondary intervention following EVAR, but 30-day morbidity and mortality rates were significant and must be taken into account during primary decision making for endovascular or open repair. </li></ul><ul><li>Proximal extender cuffs may not be a durable treatment for type Ia endoleak. </li></ul>CONCLUSION

×