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8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery.

Luo H, Huang B, Yuan D, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Du X, Wen X, Liu C, Yang H, Zhao J - PLoS ONE (2015)

Bottom Line: There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs.However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs.In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs.

View Article: PubMed Central - PubMed

Affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.

ABSTRACT

Purpose: To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.

Patients and methods: From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.

Result: There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization.

Conclusion: IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.

No MeSH data available.


Related in: MedlinePlus

a: No significant difference was found in the survival analysis of endoleak between groups A and B (A: group A, B: group B) (P = .537).Internal iliac artery (IIA) coverage with embolization did not reduce the long-term risk of endoleak. b: No significant difference was identified in the survival analysis of patency between groups A and B (A: group A, B: group B) (P = .143). The incidence of occlusion during follow-up was not significantly different between groups A and B. c: No significant difference was found in the survival analysis of ischemic complications between groups A and B (A: group A, B: group B) (P = .260). However, the incidence of ischemic complications was higher in group B than in group A (A: 4.84% vs B: 11.11%), and more severe ischemic complications occurred in group B.
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pone.0130586.g003: a: No significant difference was found in the survival analysis of endoleak between groups A and B (A: group A, B: group B) (P = .537).Internal iliac artery (IIA) coverage with embolization did not reduce the long-term risk of endoleak. b: No significant difference was identified in the survival analysis of patency between groups A and B (A: group A, B: group B) (P = .143). The incidence of occlusion during follow-up was not significantly different between groups A and B. c: No significant difference was found in the survival analysis of ischemic complications between groups A and B (A: group A, B: group B) (P = .260). However, the incidence of ischemic complications was higher in group B than in group A (A: 4.84% vs B: 11.11%), and more severe ischemic complications occurred in group B.

Mentions: The study spanned 8 years, from June 2006 to June 2014, and the mean follow-up period was 61.2 months. No deaths or graft-associated deaths occurred during the follow-up period. Twenty-one patients were lost during follow-up, and 115 patients were followed. The overall incidences of endoleak, occlusion, and ischemic complications were 19.1%, 5.22%, and 4.35%, respectively. The comparisons of the incidences of endoleak, stent occlusion and ischemic complications between groups A and B during follow-up are shown in Table 4. The follow-up comparison between groups A and B is presented in Fig 3 (a, b, c).


8-Year Long-Term Outcome Comparison: Two Ways to Exclude the Internal Iliac Artery during Endovascular Aorta Repair (EVAR) Surgery.

Luo H, Huang B, Yuan D, Yang Y, Xiong F, Zeng G, Wu Z, Chen X, Du X, Wen X, Liu C, Yang H, Zhao J - PLoS ONE (2015)

a: No significant difference was found in the survival analysis of endoleak between groups A and B (A: group A, B: group B) (P = .537).Internal iliac artery (IIA) coverage with embolization did not reduce the long-term risk of endoleak. b: No significant difference was identified in the survival analysis of patency between groups A and B (A: group A, B: group B) (P = .143). The incidence of occlusion during follow-up was not significantly different between groups A and B. c: No significant difference was found in the survival analysis of ischemic complications between groups A and B (A: group A, B: group B) (P = .260). However, the incidence of ischemic complications was higher in group B than in group A (A: 4.84% vs B: 11.11%), and more severe ischemic complications occurred in group B.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4507853&req=5

pone.0130586.g003: a: No significant difference was found in the survival analysis of endoleak between groups A and B (A: group A, B: group B) (P = .537).Internal iliac artery (IIA) coverage with embolization did not reduce the long-term risk of endoleak. b: No significant difference was identified in the survival analysis of patency between groups A and B (A: group A, B: group B) (P = .143). The incidence of occlusion during follow-up was not significantly different between groups A and B. c: No significant difference was found in the survival analysis of ischemic complications between groups A and B (A: group A, B: group B) (P = .260). However, the incidence of ischemic complications was higher in group B than in group A (A: 4.84% vs B: 11.11%), and more severe ischemic complications occurred in group B.
Mentions: The study spanned 8 years, from June 2006 to June 2014, and the mean follow-up period was 61.2 months. No deaths or graft-associated deaths occurred during the follow-up period. Twenty-one patients were lost during follow-up, and 115 patients were followed. The overall incidences of endoleak, occlusion, and ischemic complications were 19.1%, 5.22%, and 4.35%, respectively. The comparisons of the incidences of endoleak, stent occlusion and ischemic complications between groups A and B during follow-up are shown in Table 4. The follow-up comparison between groups A and B is presented in Fig 3 (a, b, c).

Bottom Line: There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs.However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs.In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs.

View Article: PubMed Central - PubMed

Affiliation: West China Medical School of Sichuan University, 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China.

ABSTRACT

Purpose: To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.

Patients and methods: From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.

Result: There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p<.001) and intraoperative X-ray time (5.9±0.86 min; A: 5.63±0.49 min vs. B: 6.22±1.07 min, P<.001). The 30-day mortality was approximately 0.73%. In the follow-up analysis, no significant differences were identified in the incidence of endoleak (22 subjects; type I: A: 2 vs. B: 2, p = 1.000; type II: A: 8 vs. B: 4, p = .666; type III: A: 4 vs. B: 3, p = 1.000), occlusion (5 subjects; 4.35%; A: 1 vs. B: 4, p = .180), or ischemia (9 subjects; 7.83%; A: 3 vs. B: 6, p = .301). In the analysis of group B, although there were no significant differences between subjects with unilateral and bilateral IIA embolization, but longer hospital stays were required (P<.001), and a more severe complication (skin and gluteus necrosis) occurred in 1 subject with bilateral IIA embolization.

Conclusion: IIA could be excluded during EVAR. IIA coverage without embolization had a good surgical and prognostic outcome, and this procedure was not different significantly from coverage with embolization in terms of endoleaks, patency and ischemia.

No MeSH data available.


Related in: MedlinePlus