Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series

Detalhes bibliográficos
Autor(a) principal: Garcia, R
Data de Publicação: 2022
Outros Autores: Bastos Gonçalves, F, Catarino, J, Correia, R, Bento, R, Pais, F, Ferreira, ME
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.17/4609
Resumo: INTRODUCTION: Endovascular aneurysm repair (EVAR) offers signifcant advantages on aneurysm treatment. However, the management of EVAR complications or failure often results in complex surgical approaches, sometimes requiring graft explantation which remains a major challenge and one associated with a high morbidity and mortality. The purpose of this study is to review our contemporary institutional experience with EVAR explantation. METHODS: An institutional administrative database was reviewed to identify patients who were subject of graft explantation following standard infra-renal EVAR between 2011 and 2021. Follow-up was extracted from patient charts. The primary endpoint was perioperative mortality (30-days or in-hospital). Demographics, indications for explantation and procedure details were evaluated. RESULTS: Over a 10-year period, between 2011 and 2021, there were 617 standard primary EVAR procedures performed in our institution for infrarenal aortic aneurysms. During this period, we identifed 13 patients submitted to EVAR explantation, two of which were referrals from other vascular centers. All patients were male and mean age at explantation was 71 years (range 47-81). The primary EVAR procedure took place 29 months (range 0-72) before explantation. The primary indication for EVAR was ruptured aortic aneurysm in seven patients.The majority of explantation operations were emergent (6/13, three due to unstable aorto-enteric fstula (AEF),three due to rupture) or urgent (4/13, two stable AEF, two graft infections). In 3 cases, explantation was elective(two type Ia endoleaks and one type II endoleak with sac expansion). None of the patients had been submitted to a previous attempt at endovascular salvage. All patients were submitted to transperitoneal approaches, and all required initial supracoeliac or suprarenal aortic clamping. After explantation, in situ reconstruction was performed in eight patients, six of which with complete EVAR explantation and two with partial EVAR explantation. Two in situ reconstructions were made using superfcial femoral veins, and the remaining used prosthetic grafts. Aortic ligation and extra-anatomic bypass were performed in fve cases, The 30-day mortality was 54% (seven patients) with 33% of mortality for elective repair, 50% mortality for urgent repair, and 67% mortality for emergent repair. Mean hospital stay after surgery was 48 days for survivors. Mean survival after discharge was 10 months. CONCLUSION: EVAR explantation is still a relatively rare and particularly complex procedure. When the reason for explantation is graft infection and AEF, and when performed in an emergent context, it is a particularly morbid procedure with a dismal prognosis. As the number of endovascular aneurysm repairs increase, our global experience will become increasingly important in bettering our surgical and clinical outcomes.
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spelling Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case SeriesAortic Aneurysm, AbdominalEndovascular ProceduresEndoleakGraft InfectionAortic reconstructionHSM CIR VASCINTRODUCTION: Endovascular aneurysm repair (EVAR) offers signifcant advantages on aneurysm treatment. However, the management of EVAR complications or failure often results in complex surgical approaches, sometimes requiring graft explantation which remains a major challenge and one associated with a high morbidity and mortality. The purpose of this study is to review our contemporary institutional experience with EVAR explantation. METHODS: An institutional administrative database was reviewed to identify patients who were subject of graft explantation following standard infra-renal EVAR between 2011 and 2021. Follow-up was extracted from patient charts. The primary endpoint was perioperative mortality (30-days or in-hospital). Demographics, indications for explantation and procedure details were evaluated. RESULTS: Over a 10-year period, between 2011 and 2021, there were 617 standard primary EVAR procedures performed in our institution for infrarenal aortic aneurysms. During this period, we identifed 13 patients submitted to EVAR explantation, two of which were referrals from other vascular centers. All patients were male and mean age at explantation was 71 years (range 47-81). The primary EVAR procedure took place 29 months (range 0-72) before explantation. The primary indication for EVAR was ruptured aortic aneurysm in seven patients.The majority of explantation operations were emergent (6/13, three due to unstable aorto-enteric fstula (AEF),three due to rupture) or urgent (4/13, two stable AEF, two graft infections). In 3 cases, explantation was elective(two type Ia endoleaks and one type II endoleak with sac expansion). None of the patients had been submitted to a previous attempt at endovascular salvage. All patients were submitted to transperitoneal approaches, and all required initial supracoeliac or suprarenal aortic clamping. After explantation, in situ reconstruction was performed in eight patients, six of which with complete EVAR explantation and two with partial EVAR explantation. Two in situ reconstructions were made using superfcial femoral veins, and the remaining used prosthetic grafts. Aortic ligation and extra-anatomic bypass were performed in fve cases, The 30-day mortality was 54% (seven patients) with 33% of mortality for elective repair, 50% mortality for urgent repair, and 67% mortality for emergent repair. Mean hospital stay after surgery was 48 days for survivors. Mean survival after discharge was 10 months. CONCLUSION: EVAR explantation is still a relatively rare and particularly complex procedure. When the reason for explantation is graft infection and AEF, and when performed in an emergent context, it is a particularly morbid procedure with a dismal prognosis. As the number of endovascular aneurysm repairs increase, our global experience will become increasingly important in bettering our surgical and clinical outcomes.Sociedade Portuguesa de Angiologia e Cirurgia VascularRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEGarcia, RBastos Gonçalves, FCatarino, JCorreia, RBento, RPais, FFerreira, ME2023-07-24T11:48:40Z20222022-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4609engAngiol Vasc Surg 2022;18(2):49-53info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-30T07:05:29Zoai:repositorio.chlc.min-saude.pt:10400.17/4609Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:10:14.046599Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
title Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
spellingShingle Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
Garcia, R
Aortic Aneurysm, Abdominal
Endovascular Procedures
Endoleak
Graft Infection
Aortic reconstruction
HSM CIR VASC
title_short Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
title_full Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
title_fullStr Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
title_full_unstemmed Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
title_sort Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
author Garcia, R
author_facet Garcia, R
Bastos Gonçalves, F
Catarino, J
Correia, R
Bento, R
Pais, F
Ferreira, ME
author_role author
author2 Bastos Gonçalves, F
Catarino, J
Correia, R
Bento, R
Pais, F
Ferreira, ME
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Garcia, R
Bastos Gonçalves, F
Catarino, J
Correia, R
Bento, R
Pais, F
Ferreira, ME
dc.subject.por.fl_str_mv Aortic Aneurysm, Abdominal
Endovascular Procedures
Endoleak
Graft Infection
Aortic reconstruction
HSM CIR VASC
topic Aortic Aneurysm, Abdominal
Endovascular Procedures
Endoleak
Graft Infection
Aortic reconstruction
HSM CIR VASC
description INTRODUCTION: Endovascular aneurysm repair (EVAR) offers signifcant advantages on aneurysm treatment. However, the management of EVAR complications or failure often results in complex surgical approaches, sometimes requiring graft explantation which remains a major challenge and one associated with a high morbidity and mortality. The purpose of this study is to review our contemporary institutional experience with EVAR explantation. METHODS: An institutional administrative database was reviewed to identify patients who were subject of graft explantation following standard infra-renal EVAR between 2011 and 2021. Follow-up was extracted from patient charts. The primary endpoint was perioperative mortality (30-days or in-hospital). Demographics, indications for explantation and procedure details were evaluated. RESULTS: Over a 10-year period, between 2011 and 2021, there were 617 standard primary EVAR procedures performed in our institution for infrarenal aortic aneurysms. During this period, we identifed 13 patients submitted to EVAR explantation, two of which were referrals from other vascular centers. All patients were male and mean age at explantation was 71 years (range 47-81). The primary EVAR procedure took place 29 months (range 0-72) before explantation. The primary indication for EVAR was ruptured aortic aneurysm in seven patients.The majority of explantation operations were emergent (6/13, three due to unstable aorto-enteric fstula (AEF),three due to rupture) or urgent (4/13, two stable AEF, two graft infections). In 3 cases, explantation was elective(two type Ia endoleaks and one type II endoleak with sac expansion). None of the patients had been submitted to a previous attempt at endovascular salvage. All patients were submitted to transperitoneal approaches, and all required initial supracoeliac or suprarenal aortic clamping. After explantation, in situ reconstruction was performed in eight patients, six of which with complete EVAR explantation and two with partial EVAR explantation. Two in situ reconstructions were made using superfcial femoral veins, and the remaining used prosthetic grafts. Aortic ligation and extra-anatomic bypass were performed in fve cases, The 30-day mortality was 54% (seven patients) with 33% of mortality for elective repair, 50% mortality for urgent repair, and 67% mortality for emergent repair. Mean hospital stay after surgery was 48 days for survivors. Mean survival after discharge was 10 months. CONCLUSION: EVAR explantation is still a relatively rare and particularly complex procedure. When the reason for explantation is graft infection and AEF, and when performed in an emergent context, it is a particularly morbid procedure with a dismal prognosis. As the number of endovascular aneurysm repairs increase, our global experience will become increasingly important in bettering our surgical and clinical outcomes.
publishDate 2022
dc.date.none.fl_str_mv 2022
2022-01-01T00:00:00Z
2023-07-24T11:48:40Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/4609
url http://hdl.handle.net/10400.17/4609
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Angiol Vasc Surg 2022;18(2):49-53
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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