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EVAR of AAA: Long term outcomes, disease progression and risk stratification

Abdulrasak, Mohammed LU (2020) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background
Endovasvular aortic repair (EVAR) is the most commonly utilised technique for the treatment of abdominal aortic
aneurysms (AAA) in tertiary referral centers. Detailed long-term outcomes of this technique are relatively scarce,
especially for patients presenting symptomatically with AAA. Intra-operatively, proximal type Ia endoleak, involving
blood circulating into the AAA – due to poor proximal seal of the endograft to the aortic neck region – is a feared
complication which is usually promptly treated, given its association with post-operative AAA expansion and
rupture. Aneurysmatic disease is usually considered a progressive pathology with potential for progression to
areas of the aorta beyond the... (More)
Background
Endovasvular aortic repair (EVAR) is the most commonly utilised technique for the treatment of abdominal aortic
aneurysms (AAA) in tertiary referral centers. Detailed long-term outcomes of this technique are relatively scarce,
especially for patients presenting symptomatically with AAA. Intra-operatively, proximal type Ia endoleak, involving
blood circulating into the AAA – due to poor proximal seal of the endograft to the aortic neck region – is a feared
complication which is usually promptly treated, given its association with post-operative AAA expansion and
rupture. Aneurysmatic disease is usually considered a progressive pathology with potential for progression to
areas of the aorta beyond the known aneurysmatic segment. Arterial calcifications are established as a marker for
atherosclerosis, yet the association of ilio-femoral calcification with post-operative mortality after EVAR is not
known.

Aims
1. Evaluate the long-term results of EVAR of AAA using a single endograft
2. Compare the early and late results of EVAR of symptomatically presenting patients to those treated asymptomatically
3. Study the long-term results of intra-operative treatment of type Ia endoleak using large, balloon expandable stents
4. Study the progression of aortic disease for patients treated with endovascular means in the postoperative period
5. Assess the novel ilio-femoral calcium score as a potential predictor for overall and cardiac-specific mortality after EVAR

Results
EVAR of AAA yields sustainable results in the long-term, for both symptomatic and asymptomatic patients. There
is ≈ x4 elevated early mortality in symptomatic patients as compared to asymptomatic ones. Intra-operative
treatment of type Ia endoleaks using large, balloon-expandable stents should be reserved to patients treated
acutely with EVAR. Aortic expansion beyond the sealing zone is relatively uncommon, and seems related to the
force exerted on the aortic wall by the endograft. Ilio-femoral calcium score may predict long-term overall and
cardiac mortality after EVAR, albeit the relation is weak. Therefore, further studies are needed to establish this
association. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Verhagen, Hence, Erasmus University Medical Center, Rotterdam, the Netherlands
organization
publishing date
type
Thesis
publication status
published
subject
keywords
abdominal aortic aneurysm, Endovascular aortic repair, ilio-femoral calcium score, type Ia endoleak
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2020:29
pages
73 pages
publisher
Lund University, Faculty of Medicine
defense location
Jubileumsaulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö
defense date
2020-03-18 09:00:00
ISSN
1652-8220
ISBN
978-91-7619-889-6
language
English
LU publication?
yes
id
0c8a0fc7-7d50-4db9-b7f0-246dddc13f32
date added to LUP
2020-02-18 18:47:57
date last changed
2020-02-21 12:43:58
@phdthesis{0c8a0fc7-7d50-4db9-b7f0-246dddc13f32,
  abstract     = {{Background<br/>Endovasvular aortic repair (EVAR) is the most commonly utilised technique for the treatment of abdominal aortic<br/>aneurysms (AAA) in tertiary referral centers. Detailed long-term outcomes of this technique are relatively scarce,<br/>especially for patients presenting symptomatically with AAA. Intra-operatively, proximal type Ia endoleak, involving<br/>blood circulating into the AAA – due to poor proximal seal of the endograft to the aortic neck region – is a feared<br/>complication which is usually promptly treated, given its association with post-operative AAA expansion and<br/>rupture. Aneurysmatic disease is usually considered a progressive pathology with potential for progression to<br/>areas of the aorta beyond the known aneurysmatic segment. Arterial calcifications are established as a marker for<br/>atherosclerosis, yet the association of ilio-femoral calcification with post-operative mortality after EVAR is not<br/>known.<br/><br/>Aims<br/>1. Evaluate the long-term results of EVAR of AAA using a single endograft<br/>2. Compare the early and late results of EVAR of symptomatically presenting patients to those treated asymptomatically<br/>3. Study the long-term results of intra-operative treatment of type Ia endoleak using large, balloon expandable stents<br/>4. Study the progression of aortic disease for patients treated with endovascular means in the postoperative period<br/>5. Assess the novel ilio-femoral calcium score as a potential predictor for overall and cardiac-specific mortality after EVAR<br/><br/>Results<br/>EVAR of AAA yields sustainable results in the long-term, for both symptomatic and asymptomatic patients. There<br/>is ≈ x4 elevated early mortality in symptomatic patients as compared to asymptomatic ones. Intra-operative<br/>treatment of type Ia endoleaks using large, balloon-expandable stents should be reserved to patients treated<br/>acutely with EVAR. Aortic expansion beyond the sealing zone is relatively uncommon, and seems related to the<br/>force exerted on the aortic wall by the endograft. Ilio-femoral calcium score may predict long-term overall and<br/>cardiac mortality after EVAR, albeit the relation is weak. Therefore, further studies are needed to establish this<br/>association.}},
  author       = {{Abdulrasak, Mohammed}},
  isbn         = {{978-91-7619-889-6}},
  issn         = {{1652-8220}},
  keywords     = {{abdominal aortic aneurysm, Endovascular aortic repair, ilio-femoral calcium score, type Ia endoleak}},
  language     = {{eng}},
  number       = {{2020:29}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{EVAR of AAA: Long term outcomes, disease progression and risk stratification}},
  url          = {{https://lup.lub.lu.se/search/files/76305023/M.Abd_Kappa.pdf}},
  year         = {{2020}},
}