Total endovascular repair of the aortic arch: initial experience in the Netherlands (Commentary)
Publication date: Available online 31 October 2019Source: The Annals of Thoracic SurgeryAuthor(s): Marvin D. Atkins, Michael J. Reardon
Abdominal aortic aneurysm (AAA) is a life-threatening disease, and the only curative treatment relies on open or endovascular repair. The decision to treat relies on the evaluation of the risk of AAA growth and rupture, which can be difficult to assess in practice. Artificial intelligence (AI) has revealed new insights into the management of cardiovascular diseases, but its application in AAA has so far been poorly described. The aim of this review was to summarize the current knowledge on the potential applications of AI in patients with AAA.
There is a growing body of literature raising concerns about the long-term durability of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), suggesting that long-term outcomes may be better after open AAA repair. However, the data investigating these long-term outcomes largely originate from early in the endovascular era and therefore do not account for increasing clinical experience and technologic improvements. We investigated whether 4-year outcomes after EVAR and open repair have improved over time.
Increasing experience and improving technology have led to the expansion of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (AAA). We investigated whether the 5-year survival after both EVAR and open repair for ruptured AAA changed over the last 14 years.
This study investigates primarily the influence of different acquisition systems (Allura ClarityIQ vs. Allura Xper, Philips Healthcare, Best, the Netherlands) on radiation dose. Secondly, radiation exposure was analysed for operator positions as well as for procedure and patient specific parameters.
This study aimed to clarify the impact of endovascular aneurysm repair (EVAR) on clinical outcomes in Japanese patients of advanced age with ruptured abdominal aortic aneurysm (rAAA).
The objective of this study was to review complications associated with lumbar drain (LD) placement perioperatively for endovascular aneurysm repair (EVAR).
In the accompanying meta-analysis, the authors provide us with a methodical review of the literature describing the treatment of type II endoleaks after endovascular aneurysm repair (EVAR) and conclude that a translumbar approach may be preferred to the transarterial route.1 On reading this paper, I am struck by how little progress we have made in our understanding of the pathophysiologic mechanism, significance, and treatment of type II endoleaks. In fact, this analysis comes to similar conclusions as reviews published as long as 6 years ago,2 highlighting the static nature of our understanding.
Endovascular aneurysm repair (EVAR) is a minimally invasive approach to repair of thoracoabdominal aneurysms (TAA) in patients who are poor surgical candidates. Aneurysms that involve the origin of the visceral branches of the abdominal aorta can be challenging to manage due to the inability of conventional stents to manage blood flow to vital organs when using fenestration and snorkeling approaches. Here, we review the efficacy and potential adverse effects of a novel modified octopus technique using an iliac branch device (IBD) in the management of these patients.
CT angiography offers excellent anatomic detail necessary for vascular procedural planning including endovascular aneurysm repair (EVAR). However, patients with renal insufficiency are at risk for acute renal failure due to iodinated contrast administration. Catheter-directed CT angiography is a technique in which dilute iodinated contrast is injected into an intra-aortic pigtail catheter during the CT scan. The purpose of this study was to evaluate the safety and efficacy of this technique.
ConclusionsWhole-aorta tMIP-CTA on time-resolved imaging is useful for maintaining contrast enhancement and image quality for EVAR planning, and can substantially reduce the amount of CM.