EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak.

INTRODUCTION: Re-interventions are still the Achilles' heel of endovascular aneurysm repair (EVAR). Ectatic common iliac arteries (CIA) can be treated with flared iliac limbs but a dilated artery used as sealing zone could increase the risk of a late type 1b endoleak. The aim of the present analysis was to evaluate the risk of late type 1b endoleak after EVAR in patients with CIA limbs ≥20 mm compared with those <20 mm. METHODS: A retrospective analysis was performed of patients treated by EVAR at the study institution between 2006 and 2012, including patients with available information about the type of iliac stent grafts and a minimum follow-up (FU) of 3 years with contrast enhanced CT, or those that had developed a type 1b endoleak earlier. The cohort was divided into two groups: Group I included iliac limbs with a distal diameter <20 mm, and Group II included all iliac limbs with a distal diameter ≥20 mm. RESULTS: Of 692 limbs (346 patients), 239 limbs (34.5%) from 129 patients were included in the analysis. Mean CT FU was 53 months, 178 had an iliac stent graft diameter <20 mm (Group I), and 61 a diameter of ≥20 mm (Group II). Mean oversizing for iliac limbs was 17.2% (IQR 14) and there was no case of immediate type 1b endoleak. For the whole group, 18 type 1b endoleaks occurred during FU (7.5%) after a mean of 37.7 months (range 4-96). Eleven of 61 (18%) iliac limbs in Group II developed a type 1b endoleak during FU in contrast to 7/178 (3.9%) in Group I (OR 5.3, 95% CI 1.98-14.59, p = 0,001). The ROC curve analysis indicated a limb diameter of 19 mm as a cutoff value for a higher probability of developing a type 1b endoleak. CONCLUSION: Patients treated with iliac limbs ≥20 mm had a fivefold higher risk of late (mean 37 months) type 1b endoleak compared with patients treated with a distal iliac limb diameter <20 mm.

Single Centre Results of Total Endovascular Repair of Complex Aortic Aneurysms with Custom Made Anaconda Fenestrated Stent Grafts.

OBJECTIVE: Fenestrated endovascular aneurysm repair (F-EVAR) has increased the number of patients with aneurysmal disease and a short or no existing neck being eligible for endovascular treatment. The aim of the study is to report experience using the Anaconda fenestrated device with special emphasis on target vessel patency and pitfalls with the device. METHODS: Between 2011 and 2016, 48 F-EVAR procedures were performed in 37 males and 11 females under general anaesthesia using the Anaconda custom made device (CMD). Cerebrospinal fluid drainage was performed in selected cases only. Primary endpoints were 30 day mortality and any stent graft related complications. RESULTS: The median aneurysm diameter was 56 mm. Most of the patients had a juxtarenal aneurysm and six had an aorto-iliac aneurysm. The primary technical success was 94% with three unsuccessful cannulations of reno-visceral arteries, two of which were successfully performed later. In the third patient an open repair was necessary because of occlusion of the main graft. The 30 day mortality was 4% because of colonic ischemia with two thrombotic occlusions of the superior mesenteric artery. Thirty day morbidity included four cases (8%) of acute limb ischemia: one with a complete limb occlusion caused by a torsion of the main body; two cases (4%) of assumed temporary spinal cord ischemia; six cases (12%) of acute renal failure; and 16 endoleaks (33%) (15 type II, 1 type III). During the median 24 months (range 0-53) follow up, three patients died (6%). One had migration of the stent graft, leading to open repair and post-operative multi-organ failure. The second had graft limb occlusion and died because of multi-organ failure caused by post-operative thrombosis of the reno-visceral stents. The third patient died of an unrelated cause. Two occlusions of the right renal stent/artery were detected. Moreover, there were three cases (6%) of late partial and seven cases (15%) of total graft limb thrombosis, with one being bilateral. CONCLUSIONS: "Real world" feasibility of the fenestrated Anaconda stent graft is demonstrated with 4% peri-operative mortality. Target vessel patency is in line with other series; however, limb thrombosis during follow up is of concern.

Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry.

OBJECTIVE: To assess safety, effectiveness and clinical outcome of the conformable thoracic aortic endograft (CTAG) in the treatment of aortic arch pathologies. METHODS: Between October 2009 and December 2010, 100 consecutive patients (65 men; mean age 65 years) with aortic arch pathologies were treated with the CTAG device in five European centres. Indications were thoracic aortic aneurysm (n = 57), Type B dissection (n = 24), intramural haematoma (n = 4), penetrating aortic ulcer (n = 9), and traumatic transection (n = 6). Emergency procedures were performed in 33%. The proximal landing zone (LZ) was LZ 0 in 7%, LZ 1 in14%, LZ 2 in 43%, and LZ 3 in 36%. Data were collected prospectively and analysed for technical and clinical success. Conformability and deployment accuracy were analysed on intra-operative angiography and post-operative computed tomography. Mean follow up was 24 ± 19 months (range, 0.3-36 months). RESULTS: The 30 day, 1 and 2 year survival rates were 90%, 81%, and 74% respectively. The 2 year survival was 80% in the elective and 62% in the emergency groups (p = .20). The major 30 day complication rate was 34%: primary Type Ia endoleak affected 1%, retrograde dissection in 1%, and the paraplegia and stroke rates at 30 days were 4% and 11%. Age > 70 years was an independent predictor for mortality and complications. The primary technical success rate was 92%; device deployment was successful in 100% and accurate in 99%. Conformability to the aortic arch was achieved in 95%. CONCLUSION: The CTAG stent graft shows high deployment accuracy, good conformability, and clinical effectiveness in the treatment of aortic arch pathologies. However, thoracic endovascular aortic repair in the arch is associated with a relatively high stroke rate. Further studies with more patients and longer follow up are needed to evaluate the long-term results.

Impairment of erectile function after elective repair of abdominal aortic aneurysm.

The purpose of the present study was to compare the functional change of erectile dysfunction after endovascular repair (EVAR) and open repair (OR) of abdominal aortic aneurysm.Between April 2009 and December 2011, male patients admitted for elective treatment of an asymptomatic infrarenal abdominal aortic aneurysm were included. The erectile function was evaluated by using a validated KEED questionnaire. All patients filled out the questionnaire preoperatively and postoperatively after one year.The number of patients with an increase of erectile dysfunction was 8 (26.6%) to 16 (53.3%) in open repair group vs. 30 (42.6%) to 40 (58.8%) in endovascular aneurysm repair. There was no statistically significant difference between open repair and endovascular aneurysm repair groups in order of new incidence of erectile dysfunction (p = 0.412). The study showed an increase in the mean value of Erectile Dysfunction -Score postoperatively in both the groups as well.The present study showed an increase of erectile dysfunction postoperatively, but the difference between the two groups was not statistically significant.

Endovascular aneurysm repair of aortoiliac aneurysms with an iliac side-branched stent graft: studying the morphological applicability of the Cook device.

OBJECTIVE/BACKGROUND: Endovascular aneurysm (EVAR) repair of an aortic aneurysm extending to the iliac artery remains a challenge. Interventional occlusion of the internal iliac artery (IIA) intending to create a distal landing zone in the external iliac artery is a common approach with inherent morbidity (e.g., buttock claudication, impotence). Alternatively, iliac side-branched stent grafts can maintain pelvic blood supply, but the applicability is limited. The objective was to investigate the morphological applicability of the Cook Zenith branched graft (ZBIS) among patients with aorto-iliac or isolated iliac aneurysms. METHODS: This was a retrospective single centre analysis of 66 patients (60 men; median age 74 years, range 53-90 years) undergoing repair of aorto-iliac aneurysms (open repair, IIA occlusion prior to EVAR and ZBIS) between January 2008 and December 2012. All available computed tomography angiograms with post-processing imaging were compared with the criteria for morphological applicability to (i) the manufacturer's instruction for use (IFU), and (ii) to criteria published in the literature, as well as (iii) to the institutional protocol. RESULTS: In 66 patients, 88 targeted iliac aneurysms were studied. Of these, 36/88 (40.9%) were compliant with the manufacturer's IFU, 35/88 (39.8%) were compliant with the published criteria, and 51/88 (58.0%) were compliant with the in house protocol. The most common morphological exclusion criterion was an aneurysmal IIA. CONCLUSION: In the present cohort with aorto-iliac aneurysm, a maximum of 58% could have been treated with an iliac side branch based on the current experience. In particular, an aneurysmal IIA seems to be a limiting factor for the use of the iliac side-branched stent graft.

F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results.

OBJECTIVE: To compare the results of elective open surgical repair (OSR) and total endovascular repair of juxtarenal aortic aneurysms (JAA), with either the Cook Zenith or the Vascutek Anaconda fenestrated stent grafts (F-EVAR) in a university hospital setting. PATIENTS AND METHODS: Between April 1999 and July 2014, of 926 patients with an abdominal aortic aneurysm, 69 were juxtarenal, where 34 had an elective OSR and 35 had F-EVAR. A post-operative rise of baseline creatinine by >50% and/or deterioration of estimated glomerular filtration rate by 25% were defined as renal failure. RESULTS: The demographics of the patients were similar except for heart insufficiency, peripheral arterial disease, and pre-existing renal artery stenosis (p < .05). Median aneurysm diameters were 57 mm (range 50-80 mm) and 56 mm (range 36-64 mm) (p = .194), respectively, and the median pre-operative serum creatinine levels were 94 µmol/L (range 65-286 µmol/L) and 96 µmol/L (range 57-333 µmol/L) (p = .871) with median estimated glomerular filtration rate of 68 mL/min (range 21-117 mL/min) and 70 mL/min (range 18-114 mL/min) (p = .308) in the open and endovascular groups, respectively. The technical success (OSR versus F-EVAR) was 100% versus 94.3% with complete exclusion of the aneurysms in all cases. Median procedure time was 171 versus 188 min. During median in hospital stay of 11 versus 7 days (p = .05), mortality was 0 versus 2.9% and new onset of post-operative renal insufficiency was detected in 26.5% versus 8.5% patients (p = .05), although with 11.8% versus 5.7% being persistent (p = .428). During follow up, statistically similar new (late or persistent post-operative) renal insufficiency was detected in 14.7% versus 8.8% with dialysis in 3% of patients in each group with similar mortality within the 24 months. CONCLUSIONS: This retrospective analysis demonstrates that OSR might be combined with more acute post-operative renal impairment than F-EVAR for JAA, but with similar intermediate term procedure related mortality and renal outcomes.

A modified approach of proximalization of arterial inflow technique for hand ischemia in patients with matured basilic and cephalic veins.

OBJECTIVE: Proximalization of arteriovenous inflow (PAI) is an established technique for treating patients with access-induced hand ischemia. However, a prosthetic graft, used as arterial inflow, could minimize the benefits of a purely native fistula. In this study, a new PAI technique is reported, which avoids the use of prosthetic grafts in patients with matured basilic and cephalic veins. PATIENTS AND METHODS: Eight patients (seven men, one woman; mean age 62 (45-82) years old) with grade III/IV critical dialysis access-related ischemia (DARI) and with a pre-existing Gracz fistula underwent an operation using modified PAI. The basilic and cephalic veins were preoperatively matured. During the operation, the former arteriovenous anastomosis was closed and the basilic vein was used as arterial inflow. RESULTS: All procedures were technically successful. All patients but one could be discharged with a warm, neurologically improved extremity with a significant reduction in pain. After a mean follow-up of 43.5 (0-52) months, there were no recurrent steal symptoms and all necrotic hand lesions healed. Two patients died during the follow-up, but with well-functioning fistulae. One fistula failed during follow-up and one further fistula was ligated because of chronic neurological damage, which was not improved after the PAI procedure. Four AVFs are still available for hemodialysis. CONCLUSIONS: The modification of the PAI technique with a basilic vein as presented here showed similar results to the original PAI procedure. This new procedure does not require prosthetic grafts as in the original PAI technique or a central venous catheter and leads to the enlargement of the puncture site as a result of the superficialization of the basilic vein. Therefore, it is believed that this new technique could be a good option for those patients with matured cephalic and basilic veins who suffer from severe access-related ischemia.

Real-world performance of the new C3 Gore Excluder stent-graft: 1-year results from the European C3 module of the Global Registry for Endovascular Aortic Treatment (GREAT).

OBJECTIVES: The European C3 module of the Global Registry for Endovascular Aortic Treatment (GREAT) provides "real-world" outcomes for the new C3 Gore Excluder stent-graft, and evaluates the new deployment mechanism. This report presents the 1-year results from 400 patients enrolled in this registry. METHODS: Between August 2010 and December 2012, 400 patients (86.8% male, mean age 73.9 ± 7.8 years) from 13 European sites were enrolled in this registry. Patient demographics, treatment indication, case planning, operative details including repositioning and technical results, and clinical outcome were analyzed. RESULTS: Technical success was achieved in 396/400 (99%) patients. Two patients needed intraoperative open conversion, one for iliac rupture, the second because the stent-graft was pulled down during a cross-over catheterization in an angulated anatomy. Two patients required an unplanned chimney renal stent to treat partial coverage of the left renal artery because of upward displacement of the stent-graft. Graft repositioning occurred in 192/399 (48.1%) patients, most frequently for level readjustment with regard to the renal arteries, and less commonly for contralateral gate reorientation. Final intended position of the stent-graft below the renal arteries was achieved in 96.2% of patients. Thirty-day mortality was two (0.5%) patients. Early reintervention (≤30 days) was required in two (0.5%) patients. Mean follow-up duration was 15.9 ± 8.8 months (range 0-37 months). Late reintervention (>30 days) was required in 26 (6.5%) patients. Estimated freedom from reintervention at 1 year was 95.2% (95% CI 92.3-97%), and at 2 years 91.5% (95% CI 86.8-94.5%). Estimated patient survival at 1 year was 96% (95% CI 93.3-97.6%) and at 2 years 90.6% (95% CI 85.6-93.9%). CONCLUSIONS: Early real-world experience shows that the new C3 delivery system offers advantages in terms of device repositioning resulting in high deployment accuracy. Longer follow-up is required to confirm that this high deployment accuracy results in improved long-term durability.

Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial.

OBJECTIVES: Uncomplicated acute type B aortic dissection (AD) treated conservatively has a 10% 30-day mortality and up to 25% need intervention within 4 years. In complicated AD, stent grafts have been encouraging. The aim of the present prospective randomised trial was to compare best medical treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year. METHODS: The AD history had to be less than 14 days, and exclusion criteria were rupture, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB. RESULTS: Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17% of the cases. During the first 30 days, no deaths occurred in either group, but there were three crossovers from the BMT to the BMT+TAG group, all due to progression of disease within 1 week. There were two withdrawals from the BMT+TAG group. At the 1-year follow up there had been another two failures in the BMT group: one malperfusion and one aneurysm formation (p = .056 for all). One death occurred in the BMT+TAG group. For the overall endpoint BMT+TAG was significantly different from BMT only (p < .001). Incomplete false lumen thrombosis, was found in 13 (43%) of the TAG+BMT group and 30 (97%) of the BMT group (p < .001). The false lumen reduced in size in the BMT+TAG group (p < .001) whereas in the BMT group it increased. The true lumen increased in the BMT+TAG (p < .001) whereas in the BMT group it remained unchanged. The overall transverse diameter was the same at the beginning and after 1 year in the BMT group (42.1 mm), but in the BMT+TAG it decreased (38.8 mm; p = .062). CONCLUSIONS: Uncomplicated AD can be safely treated with the Gore TAG device. Remodelling with thrombosis of the false lumen and reduction of its diameter is induced by the stent graft, but long term results are needed.

[Metaanalysis of EVAR versus open repair for patients undergoing elective repair of abdominal aortic aneurysms]. / Aktualisierte Metaanalyse EVAR versus offene Operation zur elektiven Ausschaltung von infrarenalen Bauchaortenaneurysmen.

INTRODUCTION: Elective endovascular abdominal aneurysm repair (EVAR) has become established in the past 20 years as a therapy option for infrarenal abdominal aortic aneurysms (AAA). Even so the benefits of EVAR over open aneurysm repair (OR) are still being discussed controversially. MATERIALS AND METHODS: A random effects meta-analysis model was used to compare the surgical outcome of EVAR with that of open operations. The end points were evaluated comparatively by use of the Peto odds ratio (Peto OR) and weighted mean differences (WMD). Four prospective randomised studies (EVAR-1, DREAM, OVER, ACE) with a total of 2747 patients (EVAR 1381, OR 1366) were included in the metaanalysis. RESULTS: In comparison to OR, EVAR was associated with a significantly reduced 30-day mortality rate (Peto OR: 0.373; p<0.001). In addition, there was a statistically significant advantage of EVAR over OR with regard to aneurysm-associated mortality (Peto OR: 0.589, p=0.013) and the length of hospital stay (SD in mean: -0.494; p<0.001). In contrast OR exhibited a lower re-intervention rate than EVAR (Peto OR: 1.843, p<0.001). On consideration of long-term survival (Peto OR: 0,977; p=0.826) and health-related quality of life there were no statistically significant differences between the two therapeutic options (SD in mean: - 0.032, p=0.481). CONCLUSIONS: In spite of the clinical heterogeneity of the studies included in the metaanalysis, the data indicate that EVAR has a marked benefit with regard to surgical mortality. In the long-term course this advantage in survival is lost but this is not due to the aneurysm-associated mortality.

Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review.

OBJECTIVE: To report our early experience with total endovascular repair of aortic-arch aneurysm using double chimney-grafts and present a literature overview. PATIENTS AND METHODS: The double chimney-graft technique was performed in six male patients with contained ruptured aneurysm, dissecting aneurysm, pseudoaneurysm, penetrating aortic ulcer and proximal endoleak after TEVAR. Furthermore, a systematic electronic health database search of available articles was conducted according to PRISMA Guidelines. RESULTS: In all cases, all supra-aortic vessels had to be covered with aortic stent-graft to receive a sufficient landing and sealing zone. Chimney-grafts were introduced to the ascending aorta slightly deeper than the thoracic stent-grafts through the cut-down exposure of the common carotid arteries. We deployed aortic stent-grafts and self-expandable chimney-grafts simultaneously and successfully. The patient with contained ruptured aneurysm died due to cardiopulmonary failure on day 19, the others survived. We detected two 'gutter' endoleaks. As a result of literature search, 12 articles met the inclusion criteria. Two articles described the double-chimney technique. CONCLUSIONS: The use of double chimney-grafts is possible in high-risk patients where the proximal landing zone of endograft would be in zone 0. The available data is still limited. The long-term follow-up remains to be evaluated with the increased number of patients treated.

Five-year patency rates of renal and visceral bypasses after abdominal debranching for thoraco-abdominal aortic aneurysms.

OBJECTIVES: This article aims to report for the first time the long-term bypass graft patency after visceral hybrid repair of thoraco-abdominal aortic aneurysms (TAAAs). PATIENTS AND METHODS: Between July 2004 and September 2012 the visceral hybrid procedure was performed in 46 patients with TAAAs, who did not qualify for an open or total endovascular repair. The inflow sites of visceral revascularisation originated either from the native artery or from aortic prosthetic grafts. All patients were included in the study and were followed up with subsequent computed tomography (CT) (mean follow-up 23.5 months). RESULTS: In 46 patients (67.5 years in median; range 35-88), 164 grafts were performed. The 30-day primary patency of all grafts was 87.9%. The long-term patency remained 87.9 ± 2.7%, 86.1 ± 3.2% and 86.1 ± 3.2% after 1, 3 and 5 years, respectively. The patency of all hepatic grafts was 100%. The patency of grafts to the superior mesenteric artery was 88.8 ± 4.8% after 1, 3 and 5 years. The patency was 87.2 ± 6%, 87.2 ± 6% and 87.2 ± 6% for the left renal artery and 76 ± 7%, 69.6 ± 8.8% and 69.6 ± 8.8% for the right renal artery after 1, 3 and 5 years, respectively. CONCLUSIONS: Hybrid repair demonstrates excellent results regarding long-term bypass graft patency of renovisceral arteries except for the right renal artery.

ADSORB: a study on the efficacy of endovascular grafting in uncomplicated acute dissection of the descending aorta.

Acute dissection of the descending thoracic aorta carries a 30-day mortality of around 10% with best medical treatment (BMT). In addition, about 25% will develop an aneurysm during the following 4-5 years. This is the first ever randomised trial on acute dissections comparing BMT with BMT and stent grafting of the proximal tear in patients having an uncomplicated acute dissection of the descending aorta. The commonly used temporal definition of acute dissection being within 14 days of onset of symptoms is applied. A total of 61 patients will be randomised and followed at regular intervals (1, 3, 6, 12, 18, 24, 30 and 36 months) after acute dissection. Thrombosis of the false lumen, aortic enlargement and rupture are the primary end points. The study will examine whether aortic remodelling occurs after stent grafting in acute type B dissections, and its effect on aneurysm formation, rupture and re-intervention.

[Is there a role for risk-scoring methods in ruptured abdominal aortic aneurysm (rAAA)?]. / Was leisten Risiko-Scores beim rupturierten abdominellen Aortenaneurysma (rAAA)?

BACKGROUND: Rupture of an abdominal aortic aneurysm (rAAA) is associated with a high mortality both before and after admission to hospital. In spite of the use of expensive intensive medical therapeutic interventions 30 - 50 % of the operated patients still die. The ASA score is one of the most used scores world-wide. Use of the Glasgow aneurysm score (GAS) and the Hardman index (HI) is frequently reported in the literature to predict survival after surgical management of rAAA. With regard to the comorbidity factor severity score (CSS) no evaluated data on the mortality in cases of rAAA are available. On the basis of our own patient collective we intended to assess to what extent the risk score could give an answer to the question of therapeutic options. METHODS: In a retrospective study (7/1998 - 8/2007), 94 patients (m : f = 78 : 16) were assessed after operative management of rAAA. The validity of preoperative risk assessments on the basis of the ASA score, the CSS, the GAS and the HI with regard to intra- or postoperative death in the initial hospitalisation period was examined. Sensitivity and specificity of the score systems were determined by receiver operating characteristics (ROC) analyses. RESULTS: The age of the patients was 72.3 ±â€†9.5 years (mean ±â€†SD). Thirty-five (37.2 %) patients died in the immediate postoperative period. The areas under the receiver operating characteristics curves for ASA, GAS, HI and CSS were 0.598, 0.787, 0.742 and 0.614, respectively. CONCLUSIONS: This study revealed clear differences in the prognostic predictions of the various scores. In accord with the literature, no score gave a 100 % positive result with regard to mortality. Thus, an individual decision or, respectively, a therapeutic option cannot be reached with the help of the investigated scores. Further parameters need to be evaluated in order to make decisions about postoperative therapy.

Evidence that statins protect renal function during endovascular repair of AAAs.

OBJECTIVES: Several studies have documented a slight but significant deterioration of renal function after endovascular repair of abdominal aortic aneurysm (AAA) (EVAR). The aim of this retrospective study was therefore to investigate whether medication with statins may favourably affect perioperative renal function. MATERIAL AND METHODS: From January 2000 to January 2008, out of a total cohort of 287 elective patients receiving endovascular repair of their AAA or aortoiliac aneurysm, 127 patients were included in the present study, as their medication was reliably retrievable. Patients were divided according to whether their medication included statins (>3 months). Second, they were subdivided according to their supra- (SR) or infrarenal (IR) endograft fixation. Serum creatinine (SCr) and creatinine (CrCl) clearance were determined preoperatively, postoperatively, at 6 and 12 months. Patients with known pre-existing renal disease, with incorrect placement of the stent graft resulting in severe renal artery stenosis, and with occlusion or renal parenchymal infarction were excluded from the study. RESULTS: Patients receiving an infrarenal fixation of their graft had no change in the renal function, regardless whether they were on statins or not. In patients with SR fixation not receiving statins, a deterioration in renal function was observed in the early postoperative period ((SCr) preoperative vs. SCr postoperative: 1.02±0.2 vs. 1.11±0.28, p<0.001 and (Cr.Cl) preoperative vs. Cr.Cl postoperative: 74.1±21.4 vs. 68.0±21.4, p<0.001), whereas patients on statins experienced no change in renal function (SCr preoperative vs. SCr postoperative: 0.99±0.24 vs. 1.02±0.20n.s. and Cr.Cl preop vs. Cr.Clpostop.: 76.4±19.1 vs. 74.28±20.50, n.s.). During follow-up, a constant worsening of renal function at 6 and 12 months was observed, irrespective of the medication with statins. CONCLUSIONS: The present study suggests a slight immediate deterioration of the renal function using (SR) fixation, and this could be prevented by the use of statins. During follow-up, statins did not protect from further renal deterioration. Broader studies are needed to confirm a definitive relation between statin use and renal protection during the endovascular repair of AAA.

Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: a systematic review and meta-analysis of case series and comparative studies.

AIM: Acute complicated type B aortic dissection is a life-threatening condition. We summarized all published studies for TEVAR among patients with acute complicated typ B aortic dissection (TBAD) with respect to clinical success, complications, and outcomes. Furthermore, we determined whether TEVAR reduces death and morbidity compared with open repair for TBAD. METHODS: Studies were identified from a literature search using various databases, and included studies when three or more patients were reported and at least in-hospital mortality was reported. Data from comparative studies of TEVAR versus open repair of the descending aorta in TBAD were combined through meta-analysis. RESULTS: Seventy-six observational studies involving 1951 patients were included in the present meta-analysis. In-hospital mortality was 11.5% and other major complications (i.e., stroke (6.3%), paraplegia (4.9%), retrograde type A aortic dissection (7%), renal impairment including dialysis (6.9%), bowel infarction (4.1%), vascular problems including major amputation (2.5%)) occurred less frequently. Long-term follow-up was limited to a mean of 24 months. During this time, endovascular reintervention was required in 11.3%, surgical reintervention in 7.7%, and late aortic rupture was calculated for 3.2% of cases. A complete false lumen thrombosis was estimated to occur in 76.1% of cases. In comparative studies, 30-day/in-hospital mortality (OR=0.256, P=0.001) and paraplegia/paraparesis (OR=0.256, P=0.001) were significantly reduced for TEVAR versus open repair. In addition to that, the rate of vascular complications was reduced for TEVAR (OR=0.373, P=0.036). There was no significant difference between TEVAR and open repair in patients with acute complicated TBAD for the following outcomes: late mortality, reintervention rate, renal dysfunction (including dialysis), and stroke rate. CONCLUSION: This summary analysis suggests that endovascular treatment of complicated acute type B aortic dissection produces favourable initial outcomes and would seem to be a great addition to the treatment options for this condition. Further study of long-term outcomes is required.

Comparison of CE approved TEVAR devices.

The indications for endovascular therapy of thoracic aortic pathologies are expanding. The complexity of cases is increasing. The individual anatomy and pathology of the thoracic aorta alone and in combination create specific difficulties in stent graft delivery, deployment, and fixation. Graft design has evolved, and several new iterations of stent grafts have been introduced into clinical practice. The assessment of these new grafts is difficult, due to the changing indications for their use and a lack of large-scale clinical trials. Currently, a number of thoracic stent graft devices are available in Europe. Variable amounts of clinical data are available to support their use.