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Titolo:
Endovascular repair of aortic aneurysms: Critical events and adjunctive procedures
Autore:
Fairman, RM; Velazquez, O; Baum, R; Carpenter, J; Golden, MA; Pyeron, A; Criado, F; Barker, C;
Indirizzi:
Univ Penn, Div Vasc Surg, Philadelphia, PA USA Univ Penn Philadelphia PA USA Penn, Div Vasc Surg, Philadelphia, PA USA Univ Penn, Div Intervent Radiol, Philadelphia, PA USA Univ Penn Philadelphia PA USA Div Intervent Radiol, Philadelphia, PA USA Union Mem Hosp, Baltimore, MD USA Union Mem Hosp Baltimore MD USAUnion Mem Hosp, Baltimore, MD USA
Titolo Testata:
JOURNAL OF VASCULAR SURGERY
fascicolo: 6, volume: 33, anno: 2001,
pagine: 1226 - 1232
SICI:
0741-5214(200106)33:6<1226:EROAAC>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
AAA REPAIR; COMPLICATIONS; ENDOLEAKS; CLASSIFICATION; MULTICENTER; GRAFT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
11
Recensione:
Indirizzi per estratti:
Indirizzo: Fairman, RM Hosp Univ Penn, 4 Silverstein Pavil,3400 Spruce St, Philadelphia, PA 19105USA Hosp Univ Penn 4 Silverstein Pavil,3400 Spruce St Philadelphia PA USA 19105
Citazione:
R.M. Fairman et al., "Endovascular repair of aortic aneurysms: Critical events and adjunctive procedures", J VASC SURG, 33(6), 2001, pp. 1226-1232

Abstract

Objective: We sought to define the learning curve relative to the incidence and range of intraoperative problems and to establish guidelines for troubleshooting during the endovascular repair of infrarenal aortic aneurysms. Methods: We prospectively evaluated our first 75 consecutive cases over a 12-month period and focused on perioperative critical events and adjunctiveprocedures as categorical outcome measures collected during tile operation. Patients were separated into three groups on the basis of the date of their operation, such that group 1 consisted of our first 25 cases, group 2 our next 25 cases, and group 3 our last 25 cases. Results: At least one critical event and adjunctive procedure marked 67 (89%) of 75 cases. In 51%, there were at least two critical events and adjunctive procedures. There were no immediate open conversions or intraoperativedeaths. Access problems occurred in 28% of the 75 cases and were addressedby use of brachial-femoral artery access (30%), iliac artery/aortic bifurcation balloon angioplasty (8%), and iliofemoral conduits (4%). Craft foreshortening was the most common deployment event (44%), necessitating distal covered extensions. Iliac graft limb twists and kinks occurred in 12% of cases and were managed with balloon angioplasty and uncovered stents. General incidents included balloon ruptures (10%), arterial dissections (6%), iliacartery rupture (2.6%), and lower extremity ischemia (4%). The two cases ofiliac artery rupture were managed with distal covered extensions, and there were no cases of atheroemboli. Intraoperative endoleaks were encountered in 44% of the cases and included proximal attachment sites (15%), distal attachment sites (9%), type 2 sources, and "blushes. " Management of intraoperative endoleaks included proximal/distal covered extensions and re-ballooning. Our 30-day endoleak rate was 20%. The incidence of critical events did not decrease in the latter one third compared with the first two thirds of cases. Conclusions: Critical events occur frequently during endovascular repair of aortic aneurysms. The intraoperative problems range from the common endoleaks, access and deployment issues, and balloon ruptures, to rare but life-threatening complications such as iliac artery rupture. A toolbox of accessories that includes wires, catheters, large balloons, covered proximal and distal extensions, and uncovered stents is essential given the frequency ofadjunctive procedures. Successful aortic endografting requires more than mere familiarity with basic endovascular techniques.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/10/20 alle ore 11:29:50