Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms with Special Reference to Concomitant Ureteric Obstruction

AbstractObjectives: to study the technical feasibility and results of endovascular treatment of inflammatory abdominal aortic aneurysms (AAA).Design: prospective study.Material and methods: seven patients underwent endovascular repair of an inflammatory AAA. Five patients (8 ureters) were treated with ureteric stents CT scans were obtained one year.Results: the early technical success rate was 100%. Four ureters remained entrapped at one year. Partial regression of periaortic fibrosis was documented in three patients, while four patients showed no regression.Conclusion: endovascular reconstruction of inflammatory abdominal aneurysms is technically feasible. Further study is warranted with regard to the evolution of the periaortic fibrosis and the possible benefits for patients with concomitant hydronephrosis

Practical points of attention beyond instructions for use with the Zenith fenestrated stent graft.

Fenestrated stent grafting for endovascular repair (F-EVAR) aims to treat patients with abdominal aortic aneurysms that are unsuitable for standard EVAR because of a short or absent infrarenal neck. F-EVAR has been used initially in patients with higher surgical risk with pararenal abdominal aortic aneurysms, but F-EVAR is now increasingly considered a treatment alternative to open surgery in anatomically suitable patients. F-EVAR has benefitted from ongoing technical refinements and accumulating clinical experience but remains a relatively complex procedure. Correct indication, accurate preoperative planning, and meticulous execution are the key to long-term success. Considering the growing interest in F-EVAR worldwide, including the United States, we discuss current indications and provide advice for planning and technical execution on the basis of the senior authors' 13 years of experience

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and costbenefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. However, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. Finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity

High-quality conforming hexahedral meshes of patient-specific abdominal aortic aneurysms including their intraluminal thrombi

In order to perform finite element (FE) analyses of patient-specific abdominal aortic aneurysms, geometries derived from medical images must be meshed with suitable elements. We propose a semi-automatic method for generating conforming hexahedral meshes directly from contours segmented from medical images. Magnetic resonance images are generated using a protocol developed to give the abdominal aorta high contrast against the surrounding soft tissue. These data allow us to distinguish between the different structures of interest. We build novel quadrilateral meshes for each surface of the sectioned geometry and generate conforming hexahedral meshes by combining the quadrilateral meshes. The three-layered morphology of both the arterial wall and thrombus is incorporated using parameters determined from experiments. We demonstrate the quality of our patient-specific meshes using the element Scaled Jacobian. The method efficiently generates high-quality elements suitable for FE analysis, even in the bifurcation region of the aorta into the iliac arteries. For example, hexahedral meshes of up to 125,000 elements are generated in less than 130 s, with 94.8 % of elements well suited for FE analysis. We provide novel input for simulations by independently meshing both the arterial wall and intraluminal thrombus of the aneurysm, and their respective layered morphologies

CIRSE Standards of Practice on Management of Endoleaks Following Endovascular Aneurysm Repair

Background Endoleaks represent the most common complication after EVAR. Some types are associated with ongoing risk of aneurysm rupture and necessitate long-term surveillance and secondary interventions. Purpose This document, as with all CIRSE Standards of Practice documents, will recommend a reasonable approach to best practices of managing endoleaks. This will include imaging diagnosis, surveillance, indications for intervention, endovascular treatments and their outcomes. Our purpose is to provide recommendations based on up-to-date evidence, updating the guidelines previously published on this topic in 2013. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of clinicians with internationally recognised expertise in endoleak management. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select publications in English and relating to human subjects up to 2023. The final recommendations were formulated through consensus. Results Endoleaks may compromise durability of the aortic repair, and long-term imaging surveillance is necessary for early detection and correct classification to guide potential re-intervention. The majority of endoleaks that require treatment can be managed using endovascular techniques. This Standards of Practice document provides up-to-date recommendations for the safe management of endoleaks

Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report

<p>Abstract</p> <p>Introduction</p> <p>Endovascular aortic repair, if technically feasible, is the treatment of choice for patients with a contained ruptured aortic aneurysm who are unfit for open surgery.</p> <p>Case presentation</p> <p>We report the case of an 80-year-old Caucasian man who presented with an unusually configured, symptomatic infrarenal aortic aneurysm. His aneurysm showed an erosion of the fourth lumbar vertebra and a severely arteriosclerotic pelvic axis. A high thigh amputation of his right leg had been performed 15 months previously. On his right side, occlusion of his external iliac artery, common femoral artery, and deep femoral artery had occurred. His aneurysm was treated by a left-sided aortomonoiliac stent graft without femorofemoral revascularization, resulting in occlusions of both internal iliac arteries. No ischemic symptoms appeared, although perfusion of his right side was maintained only over epigastric collaterals.</p> <p>Conclusions</p> <p>The placement of aortomonoiliac stent grafts for endovascular treatment of infrarenal aortic aneurysms without contralateral revascularization is a feasible treatment option in isolated cases. In this report, access problems and revascularization options in endovascular aneurysm repair are discussed.</p