Stent Graft Explantation Following Endovascular Aortic Aneurysm Repair – a Case Series
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , |
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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7160 |
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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 |
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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 instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799133351916863488 |