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Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results.

Haji Zeinali AM, Marzban M, Zafarghandi M, Shirzad M, Shirani S, Mahmoodian R, Sheikhvatan M, Lotfi-Tokaldany M - Iran J Radiol (2016)

Bottom Line: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.All patients were followed up for 13-18 months.The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.

Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran.

Patients and methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed.

Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.

Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.

No MeSH data available.


Related in: MedlinePlus

Pre- and post-EVAR and TEVAR images. A, AAA pre-EVAR; B, AAA post-EVAR; C, TAA pre-TEVAR; D, TAA post-TEVAR; E, AD pre-TEVAR; F, AD post-TEVAR
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fig22637: Pre- and post-EVAR and TEVAR images. A, AAA pre-EVAR; B, AAA post-EVAR; C, TAA pre-TEVAR; D, TAA post-TEVAR; E, AD pre-TEVAR; F, AD post-TEVAR

Mentions: The main indications for endovascular intervention in the aortic aneurysm were an asymptomatic abdominal aortic aneurysm diameter > 5.5 cm or a thoracic aortic aneurysm diameter >5.0 cm, enlarging at least 0.5 cm within six months or at least 1 cm within one year, or smaller symptomatic aneurysm cases. The indications for endovascular interventions in type B aortic dissection were persistent pain despite adequate pain management and critical visceral involvement. Our inclusion and exclusion criteria for case selection were based on the large United Kingdom EVAR 1 and 2 registry for AAA (1, 7), and VALOR trial for TAA (12) (Table 2). All of the patients underwent multislice CT angiography (256-slices CT Angiography, Siemens, Berlin, Germany) with 5mm slices in our center, and current sizing was done by our expert radiologist. Then stent graft sizing and selection was performed by a team, including an interventionist, a surgeon, a radiologist and Medtronic company sizing technician (Figure 1). The Tehran heart center surgery database, operative notes, radiology records, and individual surgeon case lists were all utilized to corroborate the information. The study was approved by the institutional review board and the research committee of Tehran University of Medical Sciences.


Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results.

Haji Zeinali AM, Marzban M, Zafarghandi M, Shirzad M, Shirani S, Mahmoodian R, Sheikhvatan M, Lotfi-Tokaldany M - Iran J Radiol (2016)

Pre- and post-EVAR and TEVAR images. A, AAA pre-EVAR; B, AAA post-EVAR; C, TAA pre-TEVAR; D, TAA post-TEVAR; E, AD pre-TEVAR; F, AD post-TEVAR
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836048&req=5

fig22637: Pre- and post-EVAR and TEVAR images. A, AAA pre-EVAR; B, AAA post-EVAR; C, TAA pre-TEVAR; D, TAA post-TEVAR; E, AD pre-TEVAR; F, AD post-TEVAR
Mentions: The main indications for endovascular intervention in the aortic aneurysm were an asymptomatic abdominal aortic aneurysm diameter > 5.5 cm or a thoracic aortic aneurysm diameter >5.0 cm, enlarging at least 0.5 cm within six months or at least 1 cm within one year, or smaller symptomatic aneurysm cases. The indications for endovascular interventions in type B aortic dissection were persistent pain despite adequate pain management and critical visceral involvement. Our inclusion and exclusion criteria for case selection were based on the large United Kingdom EVAR 1 and 2 registry for AAA (1, 7), and VALOR trial for TAA (12) (Table 2). All of the patients underwent multislice CT angiography (256-slices CT Angiography, Siemens, Berlin, Germany) with 5mm slices in our center, and current sizing was done by our expert radiologist. Then stent graft sizing and selection was performed by a team, including an interventionist, a surgeon, a radiologist and Medtronic company sizing technician (Figure 1). The Tehran heart center surgery database, operative notes, radiology records, and individual surgeon case lists were all utilized to corroborate the information. The study was approved by the institutional review board and the research committee of Tehran University of Medical Sciences.

Bottom Line: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.All patients were followed up for 13-18 months.The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.

Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran.

Patients and methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed.

Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.

Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.

No MeSH data available.


Related in: MedlinePlus