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Evolution of the Diameter of Infrarenal Aortic Aneurysms Treated by EVAR and Study of the Predictive Factors of Anatomical Failure
1044 30th Annual Meeting, French Society for Vascular Surgery (SCV), Montpellier, France, June 27-29, 2015
tion >5mm of the diameter of the aneurysm were observed in 4% and 5% (p¼0.4329), and 35% and 43% (p¼0.3411) of the patients, respectively. The rates of patency of the iliac limbs at two years according to Kaplan-Meier were 92% and 95%, respectively (p¼0.2931). Conclusion: The medium term results of the treatment of AAAs with ‘‘low profile’’ stentgrafts of the last generation are comparable with those of the ‘‘standard’’ stentgrafts. The reduction in the profile makes it possible to treat more patients with ‘‘hostile’’ iliac arteries without increasing the risk of occlusion of the limbs or reintervention. http://dx.doi.org/10.1016/j.avsg.2015.06.007
Evolution of the Diameter of Infrarenal Aortic Aneurysms Treated by EVAR and Study of the Predictive Factors of Anatomical Failure Baptiste David, Philippe Amabile, Marine Gaudry, Laurence Bal, Mariangela de Masi, Serge Cohen, and Philippe Piquet Service de Chirurgie Vasculaire, CHU de la Timone, Marseille, France. Objective: To determine if the evolution of the diameter of an AAA one year after EVAR predicts the long-term evolution. Materials and Methods: Retrospective study carried out on all the patients treated by EVAR between January 2005 and July 2013 with a follow-up longer than one year. The evolution of the aortic diameter at one year then at the end of the follow-up was measured by CT or ultrasound. Three possible evolutions were identified: a decrease, an increase and a stability of the diameter with variations > 5 mm regarded as significant. Statistical analysis was carried out in order to identify predictive factors of variation of the aortic diameter. Results: 152 patients had EVAR during this period with a follow-up longer than one year. At one year, 72 patients (47.4%) had a decrease in the aortic diameter, 73 (48%) had stability and seven (4.6%) an increase. At the end of an average follow-up of 33.5 ± 22.3 months, 76 patients (50%) had a decrease in size of the aneurysmal sac, 49 (32.2%) had stability, and 27 (17.8%) had an increase in aortic diameter. Overall, an evolution was observed in 21% of the patients between the first year and the end of the follow-up and the evolution at one year cannot be regarded as predictive of the long-term result. Among the patients presenting an initial decrease, eight (11.1%) had an increase in the aortic diameter during the follow-up. Twenty-seven patients (17.8%) had an increase in the aortic diameter during the follow-up. The prognostic factors of increase in aortic diameter during the follow-up in
Annals of Vascular Surgery
multivariate analysis were an age higher than 75 years (RR¼6.52, p¼0.034) and the presence of a type 2 endoleak (RR¼16.52, p¼0.011). The predictive factors of decrease in size of the aneurysmal sac at one year in multivariate analysis were the absence of hypertension (RR¼3.18, p¼0.028), the absence of postoperative antiplatelet treatment (RR¼3.47, p¼0.032) and the absence of type 2 endoleak (RR¼4.56, p < 0.001). The only prognostic factor of decrease in diameter of the sac at the end of the follow-up, in multivariate analysis, was the absence of postoperative antiplatelet treatment (RR¼1.92, p¼0.033). Conclusion: The variation of the aortic diameter one year after EVAR is unpredictable. The patients <75 years, without hypertension or antiplatelet treatment and without type 2 endoleaks have a statistically favorable evolution. A long term monitoring is thus always necessary whatever the initial evolution of the aortic diameter and the presence or not of an endoleak. http://dx.doi.org/10.1016/j.avsg.2015.06.006
Evaluation of the Risk of Buttock Claudication After Embolization of Internal Iliac Aneurysms Augustin Pirvu, Hireche Kheira, Alberic de Lambert, Nicolas Gallet, Frederic Thony, and Jean Luc Magne Services de chirurgie vasculaire et de radiologie, CHU de Grenoble, Grenoble, France. Objectives: The aim of this study was to analyze the immediate and medium-term results of a retrospective, continuous and monocentric series of 20 embolizations of the internal iliac arteries to treat isolated hypogastric aneurysms. Materials and Methods: From 2005 to 2013 embolization was used to treat isolated internal iliac aneurysms. The contralateral iliac axis was patent in all the cases. Embolizations were carried out under local anesthesia through a contralateral percutaneous femoral route. Follow-up was clinical and by ultrasound and CT. Results: Overall 20 embolizations were carried out in patients with a mean age of 72 years. The average diameter of the embolized iliac artery was 42mm (range 30 97mm). Two patients presented a urologic symptomatology, and one had a ruptured hypogastric aneurysm. An arterial closure system was used in six cases. A covered stentgraft was used in four cases. In one patient, the stentgraft was implanted at three weeks and in three cases the implantation of the stentgraft was simultaneous with the embolization. Perioperative mortality was null. There was no failure of embolization. In two cases (10%), a transitory rise in blood creatinine was observed. Three patients (15%) presented a buttock claudication
tion >5mm of the diameter of the aneurysm were observed in 4% and 5% (p¼0.4329), and 35% and 43% (p¼0.3411) of the patients, respectively. The rates of patency of the iliac limbs at two years according to Kaplan-Meier were 92% and 95%, respectively (p¼0.2931). Conclusion: The medium term results of the treatment of AAAs with ‘‘low profile’’ stentgrafts of the last generation are comparable with those of the ‘‘standard’’ stentgrafts. The reduction in the profile makes it possible to treat more patients with ‘‘hostile’’ iliac arteries without increasing the risk of occlusion of the limbs or reintervention. http://dx.doi.org/10.1016/j.avsg.2015.06.007
Evolution of the Diameter of Infrarenal Aortic Aneurysms Treated by EVAR and Study of the Predictive Factors of Anatomical Failure Baptiste David, Philippe Amabile, Marine Gaudry, Laurence Bal, Mariangela de Masi, Serge Cohen, and Philippe Piquet Service de Chirurgie Vasculaire, CHU de la Timone, Marseille, France. Objective: To determine if the evolution of the diameter of an AAA one year after EVAR predicts the long-term evolution. Materials and Methods: Retrospective study carried out on all the patients treated by EVAR between January 2005 and July 2013 with a follow-up longer than one year. The evolution of the aortic diameter at one year then at the end of the follow-up was measured by CT or ultrasound. Three possible evolutions were identified: a decrease, an increase and a stability of the diameter with variations > 5 mm regarded as significant. Statistical analysis was carried out in order to identify predictive factors of variation of the aortic diameter. Results: 152 patients had EVAR during this period with a follow-up longer than one year. At one year, 72 patients (47.4%) had a decrease in the aortic diameter, 73 (48%) had stability and seven (4.6%) an increase. At the end of an average follow-up of 33.5 ± 22.3 months, 76 patients (50%) had a decrease in size of the aneurysmal sac, 49 (32.2%) had stability, and 27 (17.8%) had an increase in aortic diameter. Overall, an evolution was observed in 21% of the patients between the first year and the end of the follow-up and the evolution at one year cannot be regarded as predictive of the long-term result. Among the patients presenting an initial decrease, eight (11.1%) had an increase in the aortic diameter during the follow-up. Twenty-seven patients (17.8%) had an increase in the aortic diameter during the follow-up. The prognostic factors of increase in aortic diameter during the follow-up in
Annals of Vascular Surgery
multivariate analysis were an age higher than 75 years (RR¼6.52, p¼0.034) and the presence of a type 2 endoleak (RR¼16.52, p¼0.011). The predictive factors of decrease in size of the aneurysmal sac at one year in multivariate analysis were the absence of hypertension (RR¼3.18, p¼0.028), the absence of postoperative antiplatelet treatment (RR¼3.47, p¼0.032) and the absence of type 2 endoleak (RR¼4.56, p < 0.001). The only prognostic factor of decrease in diameter of the sac at the end of the follow-up, in multivariate analysis, was the absence of postoperative antiplatelet treatment (RR¼1.92, p¼0.033). Conclusion: The variation of the aortic diameter one year after EVAR is unpredictable. The patients <75 years, without hypertension or antiplatelet treatment and without type 2 endoleaks have a statistically favorable evolution. A long term monitoring is thus always necessary whatever the initial evolution of the aortic diameter and the presence or not of an endoleak. http://dx.doi.org/10.1016/j.avsg.2015.06.006
Evaluation of the Risk of Buttock Claudication After Embolization of Internal Iliac Aneurysms Augustin Pirvu, Hireche Kheira, Alberic de Lambert, Nicolas Gallet, Frederic Thony, and Jean Luc Magne Services de chirurgie vasculaire et de radiologie, CHU de Grenoble, Grenoble, France. Objectives: The aim of this study was to analyze the immediate and medium-term results of a retrospective, continuous and monocentric series of 20 embolizations of the internal iliac arteries to treat isolated hypogastric aneurysms. Materials and Methods: From 2005 to 2013 embolization was used to treat isolated internal iliac aneurysms. The contralateral iliac axis was patent in all the cases. Embolizations were carried out under local anesthesia through a contralateral percutaneous femoral route. Follow-up was clinical and by ultrasound and CT. Results: Overall 20 embolizations were carried out in patients with a mean age of 72 years. The average diameter of the embolized iliac artery was 42mm (range 30 97mm). Two patients presented a urologic symptomatology, and one had a ruptured hypogastric aneurysm. An arterial closure system was used in six cases. A covered stentgraft was used in four cases. In one patient, the stentgraft was implanted at three weeks and in three cases the implantation of the stentgraft was simultaneous with the embolization. Perioperative mortality was null. There was no failure of embolization. In two cases (10%), a transitory rise in blood creatinine was observed. Three patients (15%) presented a buttock claudication