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Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

Asciutto, G. LU ; Aronici, M.; Resch, T. LU ; Sonesson, B. LU ; Kristmundsson, T. LU and Dias, N. V. LU (2017) In European Journal of Vascular and Endovascular Surgery 54(4). p.472-479
Abstract

Objective/Background The objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the “pave and crack” technique during endovascular aneurysm repair (EVAR) of varying complexity. Methods This was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality. Results Nineteen patients underwent EVAR with EC (16 juxtarenal... (More)

Objective/Background The objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the “pave and crack” technique during endovascular aneurysm repair (EVAR) of varying complexity. Methods This was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality. Results Nineteen patients underwent EVAR with EC (16 juxtarenal or thoraco-abdominal, two infrarenal and one thoracic; four were ruptured). Fourteen patients (73.7%) had TASC D lesions. In 10 cases (52.6%) adjunctive open/endovascular procedures to improve the femoral outflow were required. EC was technically successful in all cases and all EC were patent at EVAR completion. Thirty day mortality occurred in two cases (10.5%) One of these patients had been treated for rupture. One patient required two endovascular re-interventions at 1 and 5 years post-operatively to restore patency of the EC. No open re-interventions related to the EC were necessary. After a median follow-up period of 17 (interquartile range 5–37) months, the primary assisted patency of the EC was 88.9% (SE 10.5). No new onset of claudication or lower limb amputations occurred during the follow-up. Conclusion EC allows EVAR of varying complexity without the need for open surgical ilio-femoral conduits in patients with concomitant advanced iliac occlusive disease. Intra-operative haemodynamic instability was always avoided and mid-term patency was high.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Calcification, Endoconduit, Occlusive disease, Pave and crack, Stent graft
in
European Journal of Vascular and Endovascular Surgery
volume
54
issue
4
pages
472 - 479
publisher
Elsevier
external identifiers
  • scopus:85029580357
  • wos:000412967500015
ISSN
1078-5884
DOI
10.1016/j.ejvs.2017.07.010
language
English
LU publication?
yes
id
58d00f22-9b63-47a4-acc4-dac593b12daf
date added to LUP
2017-10-06 11:11:19
date last changed
2018-04-01 04:35:54
@article{58d00f22-9b63-47a4-acc4-dac593b12daf,
  abstract     = {<p>Objective/Background The objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the “pave and crack” technique during endovascular aneurysm repair (EVAR) of varying complexity. Methods This was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality. Results Nineteen patients underwent EVAR with EC (16 juxtarenal or thoraco-abdominal, two infrarenal and one thoracic; four were ruptured). Fourteen patients (73.7%) had TASC D lesions. In 10 cases (52.6%) adjunctive open/endovascular procedures to improve the femoral outflow were required. EC was technically successful in all cases and all EC were patent at EVAR completion. Thirty day mortality occurred in two cases (10.5%) One of these patients had been treated for rupture. One patient required two endovascular re-interventions at 1 and 5 years post-operatively to restore patency of the EC. No open re-interventions related to the EC were necessary. After a median follow-up period of 17 (interquartile range 5–37) months, the primary assisted patency of the EC was 88.9% (SE 10.5). No new onset of claudication or lower limb amputations occurred during the follow-up. Conclusion EC allows EVAR of varying complexity without the need for open surgical ilio-femoral conduits in patients with concomitant advanced iliac occlusive disease. Intra-operative haemodynamic instability was always avoided and mid-term patency was high.</p>},
  author       = {Asciutto, G. and Aronici, M. and Resch, T. and Sonesson, B. and Kristmundsson, T. and Dias, N. V.},
  issn         = {1078-5884},
  keyword      = {Calcification,Endoconduit,Occlusive disease,Pave and crack,Stent graft},
  language     = {eng},
  month        = {10},
  number       = {4},
  pages        = {472--479},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results},
  url          = {http://dx.doi.org/10.1016/j.ejvs.2017.07.010},
  volume       = {54},
  year         = {2017},
}