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The Impact of Favorable and Hostile Aortic Neck Morphology on the Outcomes of Endovascular Repair of Ruptured Abdominal Aortic Aneurysms
JOURNAL OF VASCULAR SURGERY May Supplement 2013
88S Abstracts
CI, 1.3-3.9; P < .01), and any type II endoleak (OR, 1.7; 95% CI, 1.1-2.6; P < .01). SacDe was more likely to occur in smokers (OR, 1.7; 95% CI, 1.2-2.4; P < .01), and less likely to occur in patients who had iliac aneurysm repair (OR, 0.7; 95% CI, 0.5-0.95; P ¼ .02), and any re-intervention (OR, 0.6; 95% CI, 0.4-0.9; P ¼ .03). Risk adjusted (age, symptoms/rupture, reintervention, hypogastric coverage, low EF, smoking) Cox regression showed that SacIn independently predicted increase in late mortality (HR, 2.2; 95% CI, 1.4-3.7; P < .01), while SacDe had no impact (HR, 0.9; 95% CI, 0.6-1.3; P ¼ .5). Longterm survival was lower (log-rank, P < .01) in patients with SacIn (94 6 2% 1 yr and 57 6 6% 5 yr) compared to all others (99 6 1% 1 yr and 81 6 2% 5 yr). Conclusions: These data suggest that AAA sac size increase greater than 5 mm at one year, albeit infrequent is an independent predictor of late mortality and warrants close observation and early intervention. Author Disclosures: R. P. Cambria: Nothing to disclose; M. F. Conrad: Nothing to disclose; E. Ergul: Nothing to disclose; P. P. Goodney: Nothing to disclose; E. Gravereaux: Nothing to disclose; V. I. Patel: Nothing to disclose; A. Schanzer: Nothing to disclose; M. L. Schermerhorn: Nothing to disclose. RR6. Chimney and Retrograde In-Situ Branched Stentgrafting for the Treatment of Arch Aneurysms Takao Ohki, Yuji Kanaoka, Koji Maeda, Kenjirou Kaneko, Hiromasa Tachihara. Surgery, Jikei University, Minato-ku, Japan Objectives: Total arch repair (TAR) is the gold standard therapy for arch aneurysm, however, there is room for improvements. We present the outcome of our endovascular strategy for arch aneurysms. Methods: During the last 3 years, we performed Chimney technique (38 cases) and the Retrograde In-situ Branched Stent grafting (RIBS, seven cases) to treat 45 patients with arch aneurysms all of whom were considered to be at high risk for TAR. The chimney technique involves a uni or bi-lateral common carotid artery exposure and insertion of a small diameter covered stent to preserve cerebral flow in conjunction with the deployment of the main endograft in the ascending aorta. The RIBS method was developed in an aim to reduce gutter endoleak associated with the Chimney technique. The RIBS procedure is performed by puncturing the main endograft in a retrograde manner and followed by balloon dilatation and covered stent deployment. Results: The mean aneurysm diameter (short axis) was 6.6 cm. The overall OR time was 318 6 126 minutes and blood loss was 703 6 730 mL and 12 (26%) patients required blood transfusion. Endoleak was encountered in three (7.9%) cases and all were among the Chimney patients as a result of gutter EL. There were no cases with endoleak among the RIBS patients. There was one mortality (2.2 %) that resulted from intraoperative retrograde type A dissection. Stroke occurred in one case (2.2%) but it was minor and resolved completely. Combined stroke death rate was 4.4%. During a mean FU of 11.266.9 months, no aneurysm rupture has been encountered.
Conclusions: Both the Chimney technique and the RIBS procedure are safe and effective and can be considered as an alternative option for those patients unfit for TAR. RIBS appear to be advantageous in further eliminating gutter endoleak. Author Disclosures: Y. Kanaoka: Nothing to disclose; K. Kaneko: Nothing to disclose; K. Maeda: Nothing to disclose; T. Ohki: Nothing to disclose; H. Tachihara: Nothing to disclose. RR7. The Impact of Favorable and Hostile Aortic Neck Morphology on the Outcomes of Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Manish Mehta, Benjamin Burton, John Byrne, Philip S. Paty, John B. Taggert, Sean P. Roddy, Paul B. Kreienberg, R. Clement Darling. The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc, Albany, NY Objectives: During EVAR for ruptured AAA (r-AAA) inadequate aortic neck morphology often requires surgeons to expand the stent graft ‘indications for use’ (IFU). This is the first study to date that evaluates outcomes of patients with r-AAA that underwent EVAR with favorable aortic neck (f-AN) vs hostile aortic neck (h-AN), vs open surgical repair (OSR). Methods: Over a 5-year period, 180 patients with r-AAA underwent EVAR (n ¼ 74; 41.1%) or OSR (n ¼ 106; 58.9%). The 74 r-EVAR patients were divided into 2 groups based on f-AN (n ¼ 25; 33.7%) vs h-AN (n ¼ 49; 66.7%) morphology. Data was collected prospectively, and aortic neck measurements were standardized relative to the IFUs of particular stent graft. Patients were analyzed on an intention-to-treat basis and outcomes were evaluated by logistic regression multivariable analysis. Results: The 30-day mortality was the lowest in r-EVAR patients with f-AN and the highest in the OSR patients (f-AN, 8%; h-AN, 23%; OSR, 43.4%; P < .01), and both f-AN and hAN r-EVAR patients had a better cumulative 3-year survival than OSR (f-AN, 64%; h-AN, 67%; OSR, 44%; P < .01). The r-EVAR patients with h-AN had a significantly higher incidence of female gender (32% vs 19%; P < .05), mean maximum AAA diameter (7.4 cm vs 5.5 cm; P < .05), abdominal compartment syndrome (ACS) (20% vs 4%; P < .05), Type I endoleaks (16% vs 4%; P < .05), and the need for all secondary interventions (77% vs 40%; P < .05). Conclusions: For r-AAA, although EVAR provides the greatest benefit to patients with f-AN, even patients with h-AN experience a survival benefit at 3 years when compared to OSR. However, r-EVAR patients with h-AN experience a higher incidence of ACS, Type I endoleaks, and secondary interventions, and mandate vigilant follow-up. Author Disclosures: B. Burton: Nothing to disclose; J. Byrne: Nothing to disclose; R. Darling: Nothing to disclose; P. B. Kreienberg: Nothing to disclose; M. Mehta: W.L. Gore and Associates, Medtronic Inc, Aptus Endosystems, Lombard Medical Technologies, Bolton Medical, Abbott Vascular, Cordis Corporateion, Terumo Cardiovascular, Ev3 Endovascular, Trivascular Inc, Maquet Cardiovascular, Harvest Technologies, Research Grants W.L.
JOURNAL OF VASCULAR SURGERY Volume 57, Number 5S
Gore and Associates, Ev3 Endovascular, Cordis Corporation, Trivascular Inc, Consulting fees or other remuneration (payment); P. S. Paty: Nothing to disclose; S. P. Roddy: Nothing to disclose; J. B. Taggert: Nothing to disclose. RR8. Endovascular and Open Repair of Ruptured Infrarenal Abdominal Aortic Aneurysm Experience in a US Tertiary Care Center Luigi Pascarella, Richard McCann, Matthew A. Schechter, Leila Mureebe. Duke University Hospital, Durham, NC Objectives: The mortality of ruptured infrarenal abdominal aortic aneurysms (rAAA) is as high as 70%. Loss of consciousness and systolic blood pressure on presentation of less than 80 mm Hg are the most important predictors of mortality after emergent open repair (OR). Endovascular repair of abdominal aortic aneurysm (EVAR) has reduced short-term operative mortality and morbidity for elective abdominal aortic aneurysm repair and many have advocated for wider application of EVAR for rAAA. The objective of this study is to compare our experience with OR and EVAR management of rAAA. Methods: A retrospective review of all rAAA presenting to our institution from 2000 to 2011 was performed. Patients were grouped based on the surgical approach taken (OR or EVAR). Demographics,co-morbidities, mortality and morbidity rates were compared.Statistical analyses were conducted with Stata, version 12. Results: 145 patients presented with rAAA over the study period. 22% of patients underwent EVAR, 64% underwent OR and 14% declined repair. A preoperative computed tomography scan was available in 99 patients. Only one patient (0.69%) required conversion to OR from EVAR.There was no statistical difference in 30-day (EVAR, 25%; OR, 40%; P ¼ .12) and 1-year (EVAR, 31.25%; OR, 45.74%; P ¼ .5)mortality rates.Morbidity was 78% in the EVAR and 75% in OR group. Respiratory failure and abdominal compartment syndrome were the major complications in the patients undergoing EVAR, while respiratory and renal failure were most common in the patients undergoing OR. Conclusions: In contrast to recently published series, this review shows no difference in clinical outcome between EVAR and OR in the treatment of rAAA. The comorbidities and the clinical status of the patient upon arrival to the hospital remain the most important prognostic predictors of morbidity and mortality. Until randomized trial data are available, these results lead us to pursue EVAR for rAAA in stable patients with favorable anatomy rather than a more universal approach. Author Disclosures: R. McCann: Nothing to disclose; L. Mureebe: Nothing to disclose; L. Pascarella: Nothing to disclose; M. A. Schechter: Nothing to disclose.
Abstracts 89S
Manish Mehta1, Augustin J. Delago3, Edward V. Bennett2, Lewis W. Britton2, Mohammed C. El-Hajjar2, R. Clement Darling1, Philip S. Paty1, Yaron Sternbach1. 1The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc, Albany, NY; 2Albany Medical Center Hospital, Albany Medical College, Albany, NY; 3Capital Cardiology Associates, Albany Medical Center Hospital, Albany Medical College, Albany, NY Objectives: Vascular related complications negatively impact nearly 1/3 of patients undergoing transcatheter aortic valve replacement (TAVR). This study evaluates the utilization of vascular adjunctive procedures and bailouts during TAVR in the “real-world scenarios.” Methods: In 2012, we evaluated aortoiliac morphology and outcomes of 103 consecutive patients that underwent TAVR (n ¼ 53; 51%) with the structural heart team inclusive of cardiologists and cardiac & vascular surgeons, and TEVAR (n ¼ 50; 49%). Patients were evaluated on an intent-to-treat basis, and data on all adjunctive vascular procedures & bailouts was prospectively collected. Results: The 30-day mortality of TAVR (4%) and TEVAR (2%) was comparable. TAVR patents were older (mean age, 80 yrs vs 70 yrs; P < .01), and had a higher incidence of aortoiliac significant circumferential calcifications (14% vs 6%). Hostile aortoiliac access that would have excluded patients form TAVR was noted in 21 (42%) patients. Compared to TEVAR, TAVR patients had a significantly higher incidence of vascular complications (18% vs 6%; P < .05), and the need for secondary vascular procedures (48% vs 2%; P < .01) including misplaced aortic valve retrieval (n ¼ 3; 6%), aortoiliac interventions (n ¼ 10; 20%), and iliofemoral reconstructions (n ¼ 11, 22%). Conclusions: When compared to TEVAR, TAVR patients are older, have more complex aortoiliac access, have a higher incidence of vascular complications, and have a greater need for adjunctive secondary vascular procedures. Regardless, vascular surgeon’s primary involvement limits the vascular morbidity and mortality, and expands TAVR indications for use to over 40% of inoperable and high-risk patients that are currently denied treatment. Author Disclosures: E. V. Bennett: Nothing to disclose; L. W. Britton: Nothing to disclose; R. Darling: Nothing to disclose; A. J. Delago: Nothing to disclose; M. C. ElHajjar: Nothing to disclose; M. Mehta: Abbott Vascular, Inc., Cordis Corporation, Terumo Cardiovascular Systems Corporation, Trivascular, Inc, W.L. Gore & Associates, Inc, Lomard Medical Technologies Inc, Bolton Medical, Inc, Medtronic Inc, Aptus Endosystems Inc, ev3 Endovascular, Inc, Maquet Cardiovascular Harvest Technologies Corp, Research GrantsEV3 ENDOVASCULAR, INC, W.L. GORE & ASSOCIATES, INC, CORDIS CORPORATION, TRIVASCULAR, INC, Consulting fees or other remuneration (payment); P. S. Paty: Nothing to disclose; Y. Sternbach: Medtronic, Inc, Speaker’s bureau.
RR9. Vascular Surgeon’s Involvement During Transcatheter Aortic Valve Implantation Optimizes Patient Outcomes in the “Real-World Scenarios”
RR10. Type II Endoleak: An Ambiguous and Unpredictable Marker of Worse Outcome After EVAR
88S Abstracts
CI, 1.3-3.9; P < .01), and any type II endoleak (OR, 1.7; 95% CI, 1.1-2.6; P < .01). SacDe was more likely to occur in smokers (OR, 1.7; 95% CI, 1.2-2.4; P < .01), and less likely to occur in patients who had iliac aneurysm repair (OR, 0.7; 95% CI, 0.5-0.95; P ¼ .02), and any re-intervention (OR, 0.6; 95% CI, 0.4-0.9; P ¼ .03). Risk adjusted (age, symptoms/rupture, reintervention, hypogastric coverage, low EF, smoking) Cox regression showed that SacIn independently predicted increase in late mortality (HR, 2.2; 95% CI, 1.4-3.7; P < .01), while SacDe had no impact (HR, 0.9; 95% CI, 0.6-1.3; P ¼ .5). Longterm survival was lower (log-rank, P < .01) in patients with SacIn (94 6 2% 1 yr and 57 6 6% 5 yr) compared to all others (99 6 1% 1 yr and 81 6 2% 5 yr). Conclusions: These data suggest that AAA sac size increase greater than 5 mm at one year, albeit infrequent is an independent predictor of late mortality and warrants close observation and early intervention. Author Disclosures: R. P. Cambria: Nothing to disclose; M. F. Conrad: Nothing to disclose; E. Ergul: Nothing to disclose; P. P. Goodney: Nothing to disclose; E. Gravereaux: Nothing to disclose; V. I. Patel: Nothing to disclose; A. Schanzer: Nothing to disclose; M. L. Schermerhorn: Nothing to disclose. RR6. Chimney and Retrograde In-Situ Branched Stentgrafting for the Treatment of Arch Aneurysms Takao Ohki, Yuji Kanaoka, Koji Maeda, Kenjirou Kaneko, Hiromasa Tachihara. Surgery, Jikei University, Minato-ku, Japan Objectives: Total arch repair (TAR) is the gold standard therapy for arch aneurysm, however, there is room for improvements. We present the outcome of our endovascular strategy for arch aneurysms. Methods: During the last 3 years, we performed Chimney technique (38 cases) and the Retrograde In-situ Branched Stent grafting (RIBS, seven cases) to treat 45 patients with arch aneurysms all of whom were considered to be at high risk for TAR. The chimney technique involves a uni or bi-lateral common carotid artery exposure and insertion of a small diameter covered stent to preserve cerebral flow in conjunction with the deployment of the main endograft in the ascending aorta. The RIBS method was developed in an aim to reduce gutter endoleak associated with the Chimney technique. The RIBS procedure is performed by puncturing the main endograft in a retrograde manner and followed by balloon dilatation and covered stent deployment. Results: The mean aneurysm diameter (short axis) was 6.6 cm. The overall OR time was 318 6 126 minutes and blood loss was 703 6 730 mL and 12 (26%) patients required blood transfusion. Endoleak was encountered in three (7.9%) cases and all were among the Chimney patients as a result of gutter EL. There were no cases with endoleak among the RIBS patients. There was one mortality (2.2 %) that resulted from intraoperative retrograde type A dissection. Stroke occurred in one case (2.2%) but it was minor and resolved completely. Combined stroke death rate was 4.4%. During a mean FU of 11.266.9 months, no aneurysm rupture has been encountered.
Conclusions: Both the Chimney technique and the RIBS procedure are safe and effective and can be considered as an alternative option for those patients unfit for TAR. RIBS appear to be advantageous in further eliminating gutter endoleak. Author Disclosures: Y. Kanaoka: Nothing to disclose; K. Kaneko: Nothing to disclose; K. Maeda: Nothing to disclose; T. Ohki: Nothing to disclose; H. Tachihara: Nothing to disclose. RR7. The Impact of Favorable and Hostile Aortic Neck Morphology on the Outcomes of Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Manish Mehta, Benjamin Burton, John Byrne, Philip S. Paty, John B. Taggert, Sean P. Roddy, Paul B. Kreienberg, R. Clement Darling. The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc, Albany, NY Objectives: During EVAR for ruptured AAA (r-AAA) inadequate aortic neck morphology often requires surgeons to expand the stent graft ‘indications for use’ (IFU). This is the first study to date that evaluates outcomes of patients with r-AAA that underwent EVAR with favorable aortic neck (f-AN) vs hostile aortic neck (h-AN), vs open surgical repair (OSR). Methods: Over a 5-year period, 180 patients with r-AAA underwent EVAR (n ¼ 74; 41.1%) or OSR (n ¼ 106; 58.9%). The 74 r-EVAR patients were divided into 2 groups based on f-AN (n ¼ 25; 33.7%) vs h-AN (n ¼ 49; 66.7%) morphology. Data was collected prospectively, and aortic neck measurements were standardized relative to the IFUs of particular stent graft. Patients were analyzed on an intention-to-treat basis and outcomes were evaluated by logistic regression multivariable analysis. Results: The 30-day mortality was the lowest in r-EVAR patients with f-AN and the highest in the OSR patients (f-AN, 8%; h-AN, 23%; OSR, 43.4%; P < .01), and both f-AN and hAN r-EVAR patients had a better cumulative 3-year survival than OSR (f-AN, 64%; h-AN, 67%; OSR, 44%; P < .01). The r-EVAR patients with h-AN had a significantly higher incidence of female gender (32% vs 19%; P < .05), mean maximum AAA diameter (7.4 cm vs 5.5 cm; P < .05), abdominal compartment syndrome (ACS) (20% vs 4%; P < .05), Type I endoleaks (16% vs 4%; P < .05), and the need for all secondary interventions (77% vs 40%; P < .05). Conclusions: For r-AAA, although EVAR provides the greatest benefit to patients with f-AN, even patients with h-AN experience a survival benefit at 3 years when compared to OSR. However, r-EVAR patients with h-AN experience a higher incidence of ACS, Type I endoleaks, and secondary interventions, and mandate vigilant follow-up. Author Disclosures: B. Burton: Nothing to disclose; J. Byrne: Nothing to disclose; R. Darling: Nothing to disclose; P. B. Kreienberg: Nothing to disclose; M. Mehta: W.L. Gore and Associates, Medtronic Inc, Aptus Endosystems, Lombard Medical Technologies, Bolton Medical, Abbott Vascular, Cordis Corporateion, Terumo Cardiovascular, Ev3 Endovascular, Trivascular Inc, Maquet Cardiovascular, Harvest Technologies, Research Grants W.L.
JOURNAL OF VASCULAR SURGERY Volume 57, Number 5S
Gore and Associates, Ev3 Endovascular, Cordis Corporation, Trivascular Inc, Consulting fees or other remuneration (payment); P. S. Paty: Nothing to disclose; S. P. Roddy: Nothing to disclose; J. B. Taggert: Nothing to disclose. RR8. Endovascular and Open Repair of Ruptured Infrarenal Abdominal Aortic Aneurysm Experience in a US Tertiary Care Center Luigi Pascarella, Richard McCann, Matthew A. Schechter, Leila Mureebe. Duke University Hospital, Durham, NC Objectives: The mortality of ruptured infrarenal abdominal aortic aneurysms (rAAA) is as high as 70%. Loss of consciousness and systolic blood pressure on presentation of less than 80 mm Hg are the most important predictors of mortality after emergent open repair (OR). Endovascular repair of abdominal aortic aneurysm (EVAR) has reduced short-term operative mortality and morbidity for elective abdominal aortic aneurysm repair and many have advocated for wider application of EVAR for rAAA. The objective of this study is to compare our experience with OR and EVAR management of rAAA. Methods: A retrospective review of all rAAA presenting to our institution from 2000 to 2011 was performed. Patients were grouped based on the surgical approach taken (OR or EVAR). Demographics,co-morbidities, mortality and morbidity rates were compared.Statistical analyses were conducted with Stata, version 12. Results: 145 patients presented with rAAA over the study period. 22% of patients underwent EVAR, 64% underwent OR and 14% declined repair. A preoperative computed tomography scan was available in 99 patients. Only one patient (0.69%) required conversion to OR from EVAR.There was no statistical difference in 30-day (EVAR, 25%; OR, 40%; P ¼ .12) and 1-year (EVAR, 31.25%; OR, 45.74%; P ¼ .5)mortality rates.Morbidity was 78% in the EVAR and 75% in OR group. Respiratory failure and abdominal compartment syndrome were the major complications in the patients undergoing EVAR, while respiratory and renal failure were most common in the patients undergoing OR. Conclusions: In contrast to recently published series, this review shows no difference in clinical outcome between EVAR and OR in the treatment of rAAA. The comorbidities and the clinical status of the patient upon arrival to the hospital remain the most important prognostic predictors of morbidity and mortality. Until randomized trial data are available, these results lead us to pursue EVAR for rAAA in stable patients with favorable anatomy rather than a more universal approach. Author Disclosures: R. McCann: Nothing to disclose; L. Mureebe: Nothing to disclose; L. Pascarella: Nothing to disclose; M. A. Schechter: Nothing to disclose.
Abstracts 89S
Manish Mehta1, Augustin J. Delago3, Edward V. Bennett2, Lewis W. Britton2, Mohammed C. El-Hajjar2, R. Clement Darling1, Philip S. Paty1, Yaron Sternbach1. 1The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc, Albany, NY; 2Albany Medical Center Hospital, Albany Medical College, Albany, NY; 3Capital Cardiology Associates, Albany Medical Center Hospital, Albany Medical College, Albany, NY Objectives: Vascular related complications negatively impact nearly 1/3 of patients undergoing transcatheter aortic valve replacement (TAVR). This study evaluates the utilization of vascular adjunctive procedures and bailouts during TAVR in the “real-world scenarios.” Methods: In 2012, we evaluated aortoiliac morphology and outcomes of 103 consecutive patients that underwent TAVR (n ¼ 53; 51%) with the structural heart team inclusive of cardiologists and cardiac & vascular surgeons, and TEVAR (n ¼ 50; 49%). Patients were evaluated on an intent-to-treat basis, and data on all adjunctive vascular procedures & bailouts was prospectively collected. Results: The 30-day mortality of TAVR (4%) and TEVAR (2%) was comparable. TAVR patents were older (mean age, 80 yrs vs 70 yrs; P < .01), and had a higher incidence of aortoiliac significant circumferential calcifications (14% vs 6%). Hostile aortoiliac access that would have excluded patients form TAVR was noted in 21 (42%) patients. Compared to TEVAR, TAVR patients had a significantly higher incidence of vascular complications (18% vs 6%; P < .05), and the need for secondary vascular procedures (48% vs 2%; P < .01) including misplaced aortic valve retrieval (n ¼ 3; 6%), aortoiliac interventions (n ¼ 10; 20%), and iliofemoral reconstructions (n ¼ 11, 22%). Conclusions: When compared to TEVAR, TAVR patients are older, have more complex aortoiliac access, have a higher incidence of vascular complications, and have a greater need for adjunctive secondary vascular procedures. Regardless, vascular surgeon’s primary involvement limits the vascular morbidity and mortality, and expands TAVR indications for use to over 40% of inoperable and high-risk patients that are currently denied treatment. Author Disclosures: E. V. Bennett: Nothing to disclose; L. W. Britton: Nothing to disclose; R. Darling: Nothing to disclose; A. J. Delago: Nothing to disclose; M. C. ElHajjar: Nothing to disclose; M. Mehta: Abbott Vascular, Inc., Cordis Corporation, Terumo Cardiovascular Systems Corporation, Trivascular, Inc, W.L. Gore & Associates, Inc, Lomard Medical Technologies Inc, Bolton Medical, Inc, Medtronic Inc, Aptus Endosystems Inc, ev3 Endovascular, Inc, Maquet Cardiovascular Harvest Technologies Corp, Research GrantsEV3 ENDOVASCULAR, INC, W.L. GORE & ASSOCIATES, INC, CORDIS CORPORATION, TRIVASCULAR, INC, Consulting fees or other remuneration (payment); P. S. Paty: Nothing to disclose; Y. Sternbach: Medtronic, Inc, Speaker’s bureau.
RR9. Vascular Surgeon’s Involvement During Transcatheter Aortic Valve Implantation Optimizes Patient Outcomes in the “Real-World Scenarios”
RR10. Type II Endoleak: An Ambiguous and Unpredictable Marker of Worse Outcome After EVAR