Totally percutaneous aortic aneurysm repair: methods and outcomes using the fully integrated IntuiTrak endovascular system.

09:09 EDT 3rd August 2015 | BioPortfolio

Summary of "Totally percutaneous aortic aneurysm repair: methods and outcomes using the fully integrated IntuiTrak endovascular system."


AIM:
A totally percutaneous approach to endovascular abdominal aortic aneurysm repair (PEVAR) has been shown in multiple reports to be feasible, but carries attendant risks that appear to increase with increasing sheath size. We report our methods and sequential PEVAR case experience using a new delivery system having an integrated 19Fr introducer sheath for treatment of patients with aortic necks up to 32 mm in diameter.
METHODS:
A single institution, prospective, controlled evaluation was conducted in 57 consecutive patients with abdominal aortic aneurysm who underwent PEVAR between December 2008 and April 2010. All patients have been followed for at least 30 days.
RESULTS:
Patients presented at a mean age of 74 years with median AAA diameter of 5.4 cm preprocedurally. Calcified/tortuous access vessels were identified in 98% of patients. All PEVAR procedures with adjunctive "pre-close" use of the Prostar XL closure device were performed in a hybrid endovascular suite with patients maintained under conscious sedation and local anesthesia. The anatomically-fixed bifurcated stent graft and aortic/limb extensions as needed were implanted via the 19 Fr indwelling introducer sheath with minimal blood loss (79 mL). Technical success was 98%, with one conversion to open repair attributable to very small diameter (4 mm) access vessels. Cumulatively, major access-related complications were observed in five patients (8.8%) within 30 days.
CONCLUSION:
PEVAR using the IntuiTrak System with 19Fr introducer sheath with vessel closure facilitated by the Prostar XL device is feasible, even in patients with challenging access anatomy. Further evaluation in a prospective, multicenter, randomized trial is warranted.

Affiliation

Peripheral Vascular Intervention, St. Luke's Episcopal Hospital, Texas Heart Institute, Houston, TX, USA - zvonkoMD@aol.com.

Journal Details

This article was published in the following journal.

Name: The Journal of cardiovascular surgery
ISSN: 0021-9509
Pages: 493-501

Links

PubMed Articles [11202 Associated PubMed Articles listed on BioPortfolio]

Totally Percutaneous Endovascular Aneurysm Repair Using the Preclosing Technique: Towards the Least Invasive Therapeutic Alternative.

Endovascular aneurysm repair (EVAR) offers a minimally invasive approach for the treatment of abdominal aortic aneurysms, whereas arterial closure devices have made totally percutaneous EVAR feasible....

Long-Term Outcomes of Abdominal Aortic Aneurysm in the Medicare Population.

Background Randomized trials and observational studies have shown that perioperative morbidity and mortality are lower with endovascular repair of abdominal aortic aneurysm than with open repair, but ...

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation.

Abdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applyin...

Visceral debranching thoracic endovascular aneurysm repair for chronic dissecting thoracoabdominal aortic aneurysm.

Type II chronic dissecting thoracoabdominal aortic aneurysms are a surgically challenging disease. The conventional thoracoabdominal aortic aneurysm repair technique using cardiopulmonary bypass is a ...

One-year results of the ANCHOR trial of EndoAnchors for the prevention and treatment of aortic neck complications after endovascular aneurysm repair.

EndoAnchors have been used to address proximal aortic neck complications including type Ia endoleaks and endograft migration after endovascular aortic aneurysm repair (EVAR).

Clinical Trials [2065 Associated Clinical Trials listed on BioPortfolio]

Dutch Randomised Endovascular Aneurysm Management (DREAM-) Trial

The purpose of this trial is to assess whether the new endovascular repair technique of the abdominal aortic aneurysm (AAA) is an adequate substitute of the conventional AAA repair.

Evaluation of the Endovascular Repair for Aortic Aneurysm (EVAR) Program at LHSC

The purpose of this study is to compare the cost effectiveness, quality of life and outcomes of the endovascular stent graft repair with the open surgical repair of abdominal aortic aneury...

Elective Abdominal Aortic Aneurism - Open Versus Endovascular Repair

Abdominal aortic aneurysm (AAA) is a life threatening disease. There is a consensus to propose surgical repair in patients with a reasonable operative risk when the AAA exceeds 5 cm in dia...

Adjunctive Treatment With Doxycycline to Enhance the Durability of Endovascular Aortic Aneurysm Repair

The durability of endovascular aneurysm repair (EVAR) has been limited by development of endoleaks which may be secondary to progressive aortic degeneration by matrix metalloproteases (MMP...

Follow-up of Endovascular Aneurysm Treatment - The FEAT Trial

After endovascular abdominal aortic aneurysm repair, life-long follow-up is needed to monitor the effectiveness of exclusion of the aneurysm sac from blood flow. For this reason, aneurysm ...

Medical and Biotech [MESH] Definitions

Postoperative hemorrhage from an endovascular AORTIC ANEURYSM repaired with endoluminal placement of stent grafts (BLOOD VESSEL PROSTHESIS IMPLANTATION). It is associated with pressurization, expansion, and eventual rupture of the aneurysm.

Cardiovascular manifestations of SYPHILIS, an infection of TREPONEMA PALLIDUM. In the late stage of syphilis, sometimes 20-30 years after the initial infection, damages are often seen in the blood vessels including the AORTA and the AORTIC VALVE. Clinical signs include syphilitic aortitis, aortic insufficiency, or aortic ANEURYSM.

An abnormal balloon- or sac-like dilatation in the wall of the ABDOMINAL AORTA which gives rise to the visceral, the parietal, and the terminal (iliac) branches below the aortic hiatus at the diaphragm.

Solitary lesions of bone that typically cause a bulging of the overlying cortex bearing some resemblance to the saccular protrusion of the aortic wall in aortic aneurysm, hence the name. (Dorland, 27th ed)

An abnormal balloon- or sac-like dilatation in the wall of the THORACIC AORTA. This proximal descending portion of aorta gives rise to the visceral and the parietal branches above the aortic hiatus at the diaphragm.


Advertisement
 

Relevant Topics

Anesthesiology
Latest News Clinical Trials Research Drugs Reports Corporate
An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. Anesthesiologists are physicians who provide medical care to patients in a wide variety of (usually acute) situations. ...

Stent
Latest News Clinical Trials Research Drugs Reports Corporate
A stent is a small mesh tube that's used to treat narrow or weak arteries. Arteries are blood vessels that carry blood away from your heart to other parts of your body.  A stent is placed in an artery as part of a procedure called angioplasty. &...

Blood
Latest News Clinical Trials Research Drugs Reports Corporate
Blood is a specialized bodily fluid that delivers necessary substances to the body's cells (in animals) – such as nutrients and oxygen – and transports waste products away from those same cells.  In vertebrates, it is composed of blo...

Advertisement