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1.
Rebecca Zener George Oreopoulos Robert Beecroft Dheeraj K. Rajan Jeffrey Jaskolka Kong Teng Tan 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1167-1173
Purpose
To determine the efficacy and safety of transabdominal direct sac puncture embolization of type II endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Materials and Methods
This retrospective review included 30 patients (4 women, 26 men; mean age = 79.1 years) who underwent 33 transabdominal direct sac puncture embolization procedures for type II endoleaks after EVAR. Embolization agents included cyanoacrylate glue only (45.5%), glue/coils (36.4%), and Onyx with or without glue/coils (18.1%). Technical success was defined as complete endoleak embolization on intraprocedural fluoroscopy. The primary outcome was freedom of aneurysm growth, which was defined as ≤ 5% aneurysm sac volume change on follow-up computed tomography (CT) imaging or ≤ 5 mm aneurysm sac diameter change on ultrasound without definite endoflow. Aneurysm sac volumes before and after embolization were manually segmented from CT images. The procedural complication rate was calculated.Results
Technical success was achieved in 97% of patients (29/30). Follow-up imaging was available in 27 patients (25 CT; 2 ultrasound), and mean imaging follow-up duration was 15.5 months. Freedom of aneurysm growth was achieved in 85.2% of patients (23/27) after 1 or more embolization procedures. Median fluoroscopic and procedure times were 11.3 minutes and 90 minutes, respectively. The complication rate was 9.1% (3/33) and included 1 case of nontarget embolization with transient neuropraxia and 2 self-limiting rectus sheath hematomas relating to the percutaneous puncture site. No aneurysm-related mortality occurred during the follow-up period.Conclusions
Percutaneous transabdominal embolization is a safe and efficacious treatment for type II endoleak, with a short procedure time. 相似文献2.
Kostantinos Lagios Georgios Karaolanis Theodoros Bazinas Theodossios Perdikides Ioannis Bountouris 《Journal of vascular and interventional radiology : JVIR》2018,29(6):826-832
Purpose
To evaluate long-term efficacy of translumbar embolization of type II endoleaks exclusively supplied by the lumbar arteries in patients with growing abdominal aortic aneurysm sacs using N-butyl cyanoacrylate (NBCA) instilled via percutaneous needle access.Materials and Methods
The study included 25 patients who developed type II endoleak after endovascular aneurysm repair. Inclusion criteria for intervention were defined as sac expansion > 5 mm detected with CT angiography at 6-month follow-up or later. Translumbar infusion of NBCA directly into the patent portion of the aneurysm sac was performed in all cases. Duplex US was performed the day after the intervention, and CT angiography was performed within the first month. Subsequently, duplex US was performed at 3, 6, and 9 months, and CT angiography or CT was performed at 12 months and annually thereafter.Results
Translumbar embolization was achieved in all 25 patients. The endoleak resolved in 22 patients (88%) on duplex US performed 1 day after the embolization procedure. Three patients with persistent endoleak (12%) required repeat embolization. Two complications were detected and were managed conservatively.Conclusions
This study demonstrates the safety and efficacy of NBCA injection for treatment of type II endoleaks. This technique provides another option for the management of type II endoleaks. 相似文献3.
Woo Chul Kim Yong Sun Jeon Kee Chun Hong Jang Yong Kim Soon Gu Cho Jae Young Park 《Korean journal of radiology》2014,15(5):613-621
Objective
The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR).Materials and Methods
A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed.Results
Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed.Conclusion
Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population. 相似文献4.
Hyeon Yu Hemant Desai Ari J. Isaacson Robert G. Dixon Mark A. Farber Charles T. Burke 《Journal of vascular and interventional radiology : JVIR》2017,28(2):176-184
Purpose
To compare outcomes of type II endoleak embolization involving embolization of the endoleak nidus only vs embolization of the endoleak nidus and branch vessels in patients treated with endovascular repair of abdominal aortic aneurysms.Materials and Methods
Twenty-nine consecutive patients (mean age, 77.9 y; range, 63–88 y) with type II endoleak who underwent embolization from 2004 to 2015 were retrospectively reviewed. Patients were divided into 2 groups: embolization of endoleak nidus only (group A) and embolization of endoleak nidus and branch vessels (group B). Mean follow-up intervals were 20.5 months ± 14.7 in group A and 24.3 months ± 18.5 in group B. Outcomes were compared between groups by Mann–Whitney U and Pearson χ2 tests.Results
Mean interval from endovascular aneurysm repair to embolization was 47.6 months ± 42.9, and mean presentation time of endoleak before embolization was 23.1 months ± 25.8. Coils (n = 28) and liquid embolic agents (n = 23) were used for embolization. There were no significant differences in rates of residual endoleak (50% vs 53.8%; P = .96) or sac decrease/stabilization (62.5% vs 61.5%; P = .64). Procedure time and radiation exposure in group B (132.3 min ± 78.1; 232.4 Gy·cm2 ± 130.7) were greater than in group A (63.4 min ± 11.9; 61.5 Gy·cm2 ± 35.5; P < .01). There were no procedure-related complications.Conclusions
Embolization of the endoleak nidus and branch vessels is not superior to embolization of only the nidus in terms of occlusion of type II endoleak and change in sac size despite requiring longer procedure times and resulting in greater patient radiation exposure. 相似文献5.
Motoki Nakai Akira Ikoma Hirotatsu Sato Morio Sato Yoshiharu Nishimura Yoshitaka Okamura 《Diagnostic and interventional radiology (Ankara, Turkey)》2015,21(3):195-201
PURPOSE
We aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR).METHODS
We retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation).RESULTS
Univariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all).CONCLUSION
Our results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation.The aim of endovascular abdominal aortic aneurysm repair (EVAR) is to prevent rupture of an abdominal aortic aneurysm (AAA) by depressurizing the aneurysm and excluding it from the systemic circulation using a stent-graft. Aneurysmal sac reduction is a reliable marker for the long-term prognosis after EVAR. Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1, 2). Most type II endoleaks spontaneously disappear over time, but 10%–25% persist for more than six months after EVAR (3–6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7–11). However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12–15). Therefore, the purpose of this study was to identify the risk factors associated with late aneurysmal sac expansion after EVAR to determine possible indications for intrasac embolization and prophylactic embolization of aortic branches. 相似文献6.
Yon-Kwon Ihn Byung Moon Kim Sang Hyun Suh Dong Joon Kim Dong Ik Kim 《Korean journal of radiology》2013,14(2):329-336
Objective
A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm.Materials and Methods
Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated.Results
All aneurysms were successfully treated without any complications during the procedure. Immediate post-treatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment.Conclusion
In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms. 相似文献7.
Trong Binh Le Keun-Myoung Park Yong Sun Jeon Kee Chun Hong Soon Gu Cho 《Journal of vascular and interventional radiology : JVIR》2018,29(2):203-209
Purpose
To identify prevalence and evaluate outcomes of delayed endoleak (DEL) compared with early endoleak (EEL) after endovascular aortic aneurysm repair (EVAR).Materials and Methods
Data of 164 patients who underwent elective EVAR at a single center were retrospectively analyzed. DEL was defined as any type of endoleak that was first detected ≥ 12 months after EVAR. Patients who had < 1 year of follow-up were excluded. Endoleak was classified into a more aggressive category if a patient had > 1 type of endoleak. Analysis included 81 patients (82.7% male). Mean age was 73.1 years ± 9.3. Median follow-up duration was 43 months (range, 12–135 months).Results
Endoleak was present in 32 patients (39.5%), including 21 EEL (25.9%) and 11 DEL (13.6%). DEL consisted of 2 type I, 5 type II, 1 type III, and 3 type V (endotension). Median time to detection was 45 months (range, 15–60 months), and median follow-up duration was 62 months (range, 37–104 months). Compared with EEL, DEL had larger aneurysm diameters and higher rates of non–type II endoleak and reintervention. Type II DEL also required more reintervention procedures than type II EEL.Conclusions
DEL had a noteworthy incidence and occurred late after EVAR. It predominantly consisted of non–type II endoleak and appeared to have more reinterventions than EEL. Meticulous long-term imaging surveillance to identify and manage DEL is critical. 相似文献8.
Elena Marchiori Monika Herten Michel Bosiers Arne Schwindt Theodosios Bisdas Martin Austermann Giovanni Torsello Konstantinos Stavroulakis 《Journal of vascular and interventional radiology : JVIR》2019,30(4):531-538
Purpose
To evaluate the effectiveness and durability of intra-arterial aneurysm sac embolization for the treatment of type Ia endoleak after endovascular aneurysm repair (EVAR).Materials and Methods
From February 2011 to December 2016, 22 patients underwent embolization of a type Ia endoleak after EVAR. Four patients (18%) were treated during the index EVAR and 18 (82%) in follow-up. Five patients (23%) were treated urgently and 17 (77%) electively. The embolization was performed with the use of liquid embolic agent, coils, and/or plugs. Adjunctive neck procedures were performed in 55% (n = 12) of the patients. The primary endpoint of this study was freedom from sac enlargement. Key secondary endpoints were technical success and freedom from endoleak-related reinterventions.Results
Technical success was 100%. The 30-day mortality was 5% (n = 1; acute coronary syndrome). At a mean follow-up of 15.4 months (range 0.1–65.4) the freedom from sac enlargement rate was 76% (16 out of 21). Reintervention-free survival rates at 6, 12, and 24 months were 80%, 68% and 68%, respectively.Conclusions
In patients with persistent type Ia endoleak the embolization of the aneurysm sac with or without adjunctive neck procedures can be safely performed, leading to acceptable clinical and radiologic outcomes. 相似文献9.
Kil Sung Chae Pyoung Jeon Keon Ha Kim Sung Tae Kim Hyung Jin Kim Hong Sik Byun 《Korean journal of radiology》2010,11(5):536-541
Objective
We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (≤ 3 mm).Materials and Methods
Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA).Results
Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale ≥ 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion.Conclusion
Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials. 相似文献10.
Cong-Hui Li Xian-Hui Su Bo Zhang Yong-Feng Han Er-Wei Zhang Lei Yang Dong-Liang Zhang Song-Tao Yang Zhen-Quan Yan Bu-Lang Gao 《Korean journal of radiology》2014,15(6):850-857
Objective
Tiny cerebral aneurysms are difficult to embolize because the aneurysm''s sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms.Materials and Methods
Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up.Results
All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela.Conclusion
The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data. 相似文献11.
René Müller-Wille Walter A. Wohlgemuth Peter Heiss Philipp Wiggermann Oliver Güntner Andreas G. Schreyer Patrick Hoffstetter Christian Stroszczynski Niels Zorger 《Cardiovascular and interventional radiology》2013,36(5):1288-1295
Purpose
To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx).Methods
Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37–83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinical success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans.Result
Mean follow-up time was 26.0 (range 6–50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels.Conclusion
Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory. 相似文献12.
Claire G. Poublon Suzanne Holewijn Steven M.M. van Sterkenburg Ignace F.J. Tielliu Clark J. Zeebregts Michel M.P.J. Reijnen 《Journal of vascular and interventional radiology : JVIR》2017,28(5):637-644.e1
Purpose
To evaluate long-term outcome of GORE EXCLUDER AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, Arizona) for elective treatment of infrarenal aortic aneurysms and to evaluate performance of different generations of the device.Materials and Methods
A retrospective analysis was performed of 248 patients undergoing elective endovascular aneurysm repair with the GORE EXCLUDER between January 2000 and December 2015 in 2 hospitals. Primary endpoint was reintervention-free survival. Secondary endpoints were technical success, overall survival, rupture-free survival, endoleaks, sac diameter change (> 5 mm), limb occlusion, and migration (> 5 mm). Median follow-up time was 26 months (range, 1–190 months).Results
Assisted primary technical success was 96.8%. Reintervention-free survival for 5 and 10 years was 85.2% and 75.6%, respectively. Independent risk factors for reintervention were technical success (P < .001), type I endoleak (P < .001), and type II endoleak (P = .003). Late adverse events requiring reintervention included rupture (0.4%), limb occlusion (0.4%), and stent migration (0.4%). Type Ia (4.8%), Ib (2.8%), II (35.9%), and V (6.5%) endoleaks were reported throughout follow-up. Sac growth was more prevalent with the original GORE EXCLUDER compared with the low permeability GORE EXCLUDER (P = .001) and in the presence of type I, II, and V endoleaks (P < .05). Three conversions (1.2%) were performed. Overall survival at 5 and 10 years was 68.4% and 49.0%, with no reported aneurysm-related deaths.Conclusions
Treatment with the GORE EXCLUDER is effective with acceptable reintervention rates in the long-term and few device-related adverse events or ruptures up to 10 years. Observed late adverse events and new-onset endoleaks emphasize the need for long-term surveillance. 相似文献13.
Tamer W. Kassem 《The Egyptian Journal of Radiology and Nuclear Medicine》2017,48(3):621-626
Objective
The goal of this study was to highlight the role of follow up CT angiography examination in detection and classification of endoleaks and therefore deciding management plans after endovascular abdominal aortic aneurysm repair (EVAR).Patients and Methods
During one year duration 37 patients who have been operated were examined 1 and 6 months after EVAR as routine follow up. The images obtained were interpreted and reconstructed using dedicated software and work stations.Results
Out of 37 cases, 14 cases (37.8%) had positive endoleaks and 23 cases (62.2%) were free. Type I endoleak was diagnosed in 4 cases (10.8%) and type II endoleaks was diagnosed in 10 cases (27%) as 7 cases (18.9%) showed leak through lumbar arteries and 3 cases (8.1%) showed leak through the inferior mesenteric arteries.Conclusion
CT angiography can accurately detect and classify endoleaks and thus determine line of treatment. Endoleaks are often asymptomatic and may become evident intra operatively or many years after the operation, therefore lifelong imaging supervision is necessary. 相似文献14.
Mikolaj Wojtaszek Emilia Wnuk Rafal Maciag Krzysztof Lamparski Krzysztof Korzeniowski Olgierd Rowinski 《Journal of vascular and interventional radiology : JVIR》2017,28(2):168-175
Purpose
To evaluate the efficacy and clinical outcomes of ancillary endovascular procedures in promoting false-lumen (FL) thrombosis (FLT) and preventing aortic expansion in patients after thoracic endografting for type B dissections.Materials and Methods
This retrospective review included 15 patients (12 men and 3 women; mean age, 59.6 y). Mean aortic diameter at the time of ancillary treatment was 47.4 mm. Different techniques were used as single procedures or sequentially: covered stent occlusion of detached visceral artery entry tears, occlusion of single entry tears with vascular plugs, or aortic endograft occlusion of multiple FL entry tears. FL embolization with ethylene vinyl alcohol copolymer was performed when selective occlusion was considered insufficient to close distal entry tears. Apart from endovascular aneurysm repair, all procedures were performed percutaneously under local anesthesia. If FL diameter increase persisted after 6-month follow-up computed tomographic (CT) angiography, another intervention was planned; otherwise, yearly follow-up was performed.Results
Mean clinical follow-up duration was 43.8 months (range, 8 d to 86.8 mo), with no in-hospital mortality. Estimated overall survival rates were 93.3%, 86.6%, and 77% at 12, 24, and 48 months, respectively. Three late deaths occurred, one of which was dissection-related at 40 months. Eight surviving patients (53%) had total FLT and 3 had partial FLT with stable aortic diameter on follow-up CT angiography. FL diameter increased in one patient, requiring further intervention.Conclusions
Selective exclusion of new distal entry tears remaining after thoracic endovascular aneurysm repair can stabilize abdominal aortic expansion and promote FLT. 相似文献15.
Muhammad Zamir Michael Jenkins Nicholas Burfitt Colin Bicknell Richard Gibbs Mohamad Hamady 《Journal of vascular and interventional radiology : JVIR》2019,30(4):546-553
Purpose
To review short-term and midterm results of the fenestrated Anaconda stent graft in management of patients with pre-existing endovascular aortic stent graft and persistent type 1a endoleak.Materials and Methods
This single-center retrospective study assessed all consecutive patients with type 1a endoleak and pre-existing endovascular aneurysm repair (EVAR) treated with fenestrated Anaconda stent grafts. Ten patients (9 males; mean age 78 y) with mean follow-up of 22.4 months ± 13 were included. Average aneurysm size was 80.1 mm (range, 62–101 mm). Mean time for conversion to fenestrated EVAR following original EVAR was 53.7 months (range, 22–101 months; median 54 months). Technical and clinical success; anatomic features, including aortic tortuosity, side vessel angulation, and stenosis; complications; and reinterventions were recorded.Results
The technical success rate was 90%. There was no open conversion and no 30-day mortality, leading to a clinical success rate of 100%. Five of 10 patients demonstrated an aortic tortuosity index of grade 2 or 3. Additional hostile anatomy that made side vessel catheterization challenging was observed in 15 vessels (45%) with a stenosis of ≥ 50% (related to atherosclerotic disease or struts of indwelling prosthesis) and 21 vessels (66%) with ≤ 70° angulation. Two reinterventions, renal artery stent angioplasty and renal artery covered stent extension, were observed at 2 and 13 months.Conclusions
Use of the fenestrated Anaconda endograft in patients with type 1a endoleaks following previous EVAR is safe, feasible, and offers some technical features that facilitate overcoming certain anatomic difficulties. 相似文献16.
Objective
The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation.Materials and Methods
Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation.Results
Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures.Conclusion
The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation. 相似文献17.
Masayuki Endo Toshio Kaminou Yasufumi Ohuchi Kimihiko Sugiura Shinsaku Yata Akira Adachi Tsuyoshi Kawai Syohei Takasugi Shuichi Yamamoto Kensuke Matsumoto Masayuki Hashimoto Takashi Ihaya Toshihide Ogawa 《Japanese journal of radiology》2013,31(3):215-219
Purpose
Celiac trunk coil embolization before thoracic endovascular aneurysm repair (TEVAR) of a thoracoabdominal aortic aneurysm involving the celiac trunk can prevent type II endoleaks. One disadvantage of conventional coil embolization is the risk of coil displacement. We performed coil embolization under balloon occlusion of the celiac trunk to address this issue.Materials and methods
Between December 2008 and January 2011, 5 patients (3 men and 2 women, mean age 76 years) were included in this study. For all patients, after confirming the collateral blood flow from the superior mesenteric artery via the pancreaticoduodenal arcades by using the balloon occlusion test, celiac trunk coil embolization proceeded under balloon occlusion of the proximal part of the celiac trunk.Results
Balloon-assisted coil embolization of the celiac trunk was completed for all patients without any complications. All coils were deployed as planned in the short segment of the celiac trunk without displacement. Coil migration, ischemic complications, and endoleaks via the celiac trunk did not arise in any of the patients over a follow-up period of 77–637 (mean 258) days.Conclusions
Balloon-assisted coil embolization of the celiac trunk before TEVAR could be a feasible treatment option for suitable patients. 相似文献18.
Aortic side branch embolization before endovascular aneurysm repair: incidence of type II endoleak 总被引：5，自引：0，他引：5
Gould DA McWilliams R Edwards RD Martin J White D Joekes E Rowlands PC Brennan J Gilling-Smith G Harris PL 《Journal of vascular and interventional radiology : JVIR》2001,12(3):337-341
PURPOSE: To assess the feasibility of embolization of aortic side branches and its impact on the incidence of type II endoleak after endovascular aneurysm repair. MATERIALS AND METHODS: Endovascular aneurysm repair was performed in 74 patients. Aortic side branch vessels were evaluated on the preoperative angiogram and computed tomography (CT) and, where embolization of lumbar and inferior mesenteric vessels was considered technically possible, this was attempted prior to endovascular repair. Follow-up CT was used to assess the presence of type II endoleak. RESULTS: Seventy-two patients were followed up for longer than 1 month. Embolization was attempted in 25 cases, successfully in 10, with partial success in 11, and failure in four. Twenty patients with successful or partly successful preoperative embolization were discharged and followed-up. Four (20%) had demonstrable type II endoleak during follow-up, with two of these persisting at latest follow-up. Of 43 patients without previous embolization, there were 10 (23.3%) type II endoleaks during the follow-up period, four of these persisting. In cases with type II endoleak, mean sac diameter change was -0.5 mm in the cases with previous embolization and +3.1 mm without. The mean period to onset of type II endoleak was 6.9 months without, and 15.3 months with, previous embolization. CONCLUSION: Although the cohort size is below a level that would confer significance, the trend of these findings is such as to suggest a lack of influence of aortic side branch embolization on the incidence of type II endoleak during the follow-up period. 相似文献
19.
Ken Nakajima Noriyuki Kato Takashi Hashimoto Shuji Chino Takatoshi Higashigawa Takafumi Ouchi Toshiya Tokui Yoichiro Miyake Hajime Sakuma 《Journal of vascular and interventional radiology : JVIR》2018,29(2):188-193
Purpose
To evaluate the clinical utility of combination therapy with endovascular aneurysm repair (EVAR) and abscess drainage for the treatment of infected aneurysms.Materials and Methods
Between July 2009 and May 2015, 8 patients underwent combination therapy with EVAR and abscess drainage. There were 5 men and 3 women, with a mean age of 75 years ± 7. Aneurysms were of the thoracic aorta in 5 patients, the abdominal aorta in 2, and the internal iliac artery in 1. Four patients had concurrent infection, including pyelonephritis in 2, pelvic abscess in 1, and suppurative knee arthritis in 1. Three patients had ruptured aneurysms. Abscess drainage was performed percutaneously under computed tomographic guidance in 5 patients, thoracoscopic guidance in 2, and both in 1.Results
Six patients (75%) were discharged without additional intervention except for antibiotic therapy, and the other 2 patients (25%) underwent open repair to control infection and to repair endoleak, respectively. There were no in-hospital deaths. During the mean follow-up period of 48 months ± 22, all patients were alive except for 1 patient who died of recurrence of rectal cancer at 51 months. There were no aorta- or artery-related adverse events. Overall survival rates at 1 and 5 years were 100% and 80%, respectively. Aneurysm-related event-free rates at 1 and 5 years were 75%.Conclusions
Combination therapy with EVAR and abscess drainage for the treatment of infected aneurysms seems to be a promising strategy as an alternative or “bridge” to open surgery. 相似文献20.
Chang wei Zhang Xiao dong Xie Chao You Bo yong Mao Chao hua Wang Min He Hong Sun 《Korean journal of radiology》2010,11(6):603-611