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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.


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There was no significant difference in the incidence of postoperative ischemia between groups B1 (subjects with unilateral IIA exclusion, n = 4) and B2 (bilateral IIA exclusion, n = 2).However, B1 was obviously different from B2 in terms of hospital stays and the severity of the ischemic complications. The two subjects in B2 had hospital stays of 12 and 17 days; by contrast, the hospital stays of the subjects in B1 were 3, 5, 5, and 6 days (P < .001). A severe ischemic complication (gluteal skin necrosis) occurred in one subject in group B2 with a claudication distance of less than 100 meters. Gluteal soreness with a claudication distance of approximately 150 meters occurred in another subject in group B2. By contrast, gluteal ischemia and limb ischemia in group B1 were mild.
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pone.0130586.g004: There was no significant difference in the incidence of postoperative ischemia between groups B1 (subjects with unilateral IIA exclusion, n = 4) and B2 (bilateral IIA exclusion, n = 2).However, B1 was obviously different from B2 in terms of hospital stays and the severity of the ischemic complications. The two subjects in B2 had hospital stays of 12 and 17 days; by contrast, the hospital stays of the subjects in B1 were 3, 5, 5, and 6 days (P < .001). A severe ischemic complication (gluteal skin necrosis) occurred in one subject in group B2 with a claudication distance of less than 100 meters. Gluteal soreness with a claudication distance of approximately 150 meters occurred in another subject in group B2. By contrast, gluteal ischemia and limb ischemia in group B1 were mild.

Mentions: Endoleak occurred in 22 cases (A: 13 vs B: 9), with 4 Type I cases (A: 2 vs B: 2), 12 Type II cases (A: 8 vs B: 4), and 7 Type III cases (A: 4 vs B: 3). Type I and III endoleaks simultaneously occurred in one case. One subject in group A with a Type II endoleak underwent an endovascular intervention for an increased aneurysm and newly developed CIAA. In the other 21 cases, the endoleak disappeared or shrunk, and the size of the aneurysm did not increase during follow-up. Furthermore, the survival analysis revealed that there was no significant difference in the long-term incidence of endoleak between group A and B (P = .537; Fig 4A). Therefore, intraoperative embolization of the IIA with coils before coverage did not decrease the long-term incidence of type II endoleak.


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)

There was no significant difference in the incidence of postoperative ischemia between groups B1 (subjects with unilateral IIA exclusion, n = 4) and B2 (bilateral IIA exclusion, n = 2).However, B1 was obviously different from B2 in terms of hospital stays and the severity of the ischemic complications. The two subjects in B2 had hospital stays of 12 and 17 days; by contrast, the hospital stays of the subjects in B1 were 3, 5, 5, and 6 days (P < .001). A severe ischemic complication (gluteal skin necrosis) occurred in one subject in group B2 with a claudication distance of less than 100 meters. Gluteal soreness with a claudication distance of approximately 150 meters occurred in another subject in group B2. By contrast, gluteal ischemia and limb ischemia in group B1 were mild.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507853&req=5

pone.0130586.g004: There was no significant difference in the incidence of postoperative ischemia between groups B1 (subjects with unilateral IIA exclusion, n = 4) and B2 (bilateral IIA exclusion, n = 2).However, B1 was obviously different from B2 in terms of hospital stays and the severity of the ischemic complications. The two subjects in B2 had hospital stays of 12 and 17 days; by contrast, the hospital stays of the subjects in B1 were 3, 5, 5, and 6 days (P < .001). A severe ischemic complication (gluteal skin necrosis) occurred in one subject in group B2 with a claudication distance of less than 100 meters. Gluteal soreness with a claudication distance of approximately 150 meters occurred in another subject in group B2. By contrast, gluteal ischemia and limb ischemia in group B1 were mild.
Mentions: Endoleak occurred in 22 cases (A: 13 vs B: 9), with 4 Type I cases (A: 2 vs B: 2), 12 Type II cases (A: 8 vs B: 4), and 7 Type III cases (A: 4 vs B: 3). Type I and III endoleaks simultaneously occurred in one case. One subject in group A with a Type II endoleak underwent an endovascular intervention for an increased aneurysm and newly developed CIAA. In the other 21 cases, the endoleak disappeared or shrunk, and the size of the aneurysm did not increase during follow-up. Furthermore, the survival analysis revealed that there was no significant difference in the long-term incidence of endoleak between group A and B (P = .537; Fig 4A). Therefore, intraoperative embolization of the IIA with coils before coverage did not decrease the long-term incidence of type II endoleak.

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