Journal of vascular surgery
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The purpose of this report was to present short and midterm results of endovascular aortic aneurysm repair (EVAR) of infrarenal aortic aneurysms in octogenarians and nonagenarians. ⋯ EVAR in octogenarians and nonagenarians is associated with a significantly higher but still low perioperative mortality compared to younger patients. Midterm survival in octogenarians and nonagenarians, although significantly lower than in younger patients, is still acceptable, indicating that age >80 years should not be an exclusion criteria for EVAR. Even high-risk patients >80 years can be treated safely with a low perioperative mortality and comparable midterm outcome to younger high-risk patients.
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Comparative Study
Long-term single institution comparison of endovascular aneurysm repair and open aortic aneurysm repair.
Since the development of endovascular aneurysm repair (EVAR), there remains concerns regarding its durability, need for secondary procedures, and associated long-term morbidity. We compared these two approaches to evaluate secondary interventions and their respective long-term durability. ⋯ EVAR requires more late secondary vascular interventions than open AAA repair, but patients who undergo open repair have more nonvascular long-term morbidity. Long-term survival is better after EVAR compared to open repair in this selected patient group.
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Thrombus extension into a deep vein after superficial venous thermoablation remains a unique complication in the treatment of superficial reflux disease of the great saphenous vein (GSV). In this study, we evaluate if catheter tip positioning or vein diameter correlate with the length of proximal patent segment of GSV after ablation and more caudal catheter positioning decreases the incidence of proximal thrombus extension into the femoral vein. ⋯ In patients undergoing RFA for saphenous reflux, neither catheter tip positioning nor vein diameter correlates with the length of the proximal patent segment of GSV after ablation. In addition, catheter positioning does not decrease the incidence of proximal thrombus extension into the femoral vein.
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To determine the results of simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR). ⋯ Combined TEVAR and EVAR can be performed successfully with minimal morbidity and mortality. In particular, in this limited series of eight patients, there have been no occurrences of lower extremity paralysis or renal failure despite a high proportion of emergent cases. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as a viable alternative to staged or hybrid repair.
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Whether abdominal aortic aneurysm (AAA) enlargement after endovascular aneurysm repair (EVAR), without an identifiable endoleak, is a risk factor for AAA rupture remains controversial. To our knowledge, studies including large patient numbers investigating this topic have not been done. Therefore, a considerable number of conversions to open AAA repair have been performed in this patient group. This study evaluated AAA rupture risk in patients without detectable endoleaks but with AAA enlargement after EVAR treatment. ⋯ The risk of rupture in patients with an AAA enlargement of 8 mm after EVAR, without detectable endoleaks, is <1% in the first 4 years. No ruptures were seen in patients with AAA enlargement without detectable endoleaks who were not treated with Vanguard stent grafts (Boston Scientific Corp, Natick, Mass) and had AAA diameters <70 mm. For this group, conversion to open repair might not be mandatory, and regular follow-up can be advised instead. After 4 years of follow-up, this study observed an increased annual rupture risk, which might indicate the need for conversion; however, groups are small, and follow-up bias could play a role.