Helical EndoStaples enhance endograft fixation in an experimental model using human cadaveric aortas

ObjectiveThis study evaluated the contribution of Aptus EndoStaples (Aptus Endosystems, Sunnyvale, Calif) in the proximal fixation of eight endografts used in the endovascular repair of abdominal aortic aneurysms (EVAR).MethodsNine human cadaveric aortas were exposed, left in situ, and transected to serve as fixation zones. The Zenith (Cook, Bloomington, Ind), Anaconda (Vascutek, Inchinnan, Scotland, UK), Endurant (Medtronic, Minneapolis, Minn), Excluder (W. L. Gore and Associates, Flagstaff, Ariz), Aptus (Aptus Endosystems), Aorfix (Lombard Medical, Didcot, UK), Talent (Medtronic), and AneuRx (Medtronic) stent grafts were proximally deployed and caudal displacement force (DF) was applied via a force gauge, recording the DF required to dislocate each device ≥20 mm from the infrarenal neck. Measurements were repeated after four and six EndoStaples were applied at the proximal fixation zone, as well as after a Dacron graft was sutured at the proximal neck in standard fashion. Finally, a silicone tube was used as a control fixation zone to test the DF of grafts with EndoStaples in a material that exceeded the integrity of a typical human cadaveric aorta and provided a consistent substrate to examine the differential effect of variable degrees of EndoStaple implantation using zero, two, four, and six EndoStaples.ResultsIn the cadaveric model, the mean DF required to dislocate the endografts without the application of EndoStaples was 19.73 ± 12.52 N; this increased to 49.72 ± 12.53 N (P < .0001) when four EndoStaples where applied and to 79.77 ± 28.04 N when six EndoStaples were applied (P = .003). The DF necessary to separate the conventionally hand-sutured Dacron graft from the aorta was 56 N. In the silicone tube model, the Aptus endograft without EndoStaples withstood 3.2 N of DF. The DF increased to 39 ± 3 N when two EndoStaples were added, to 71 ± 6 N when four were added, and to 98 ± 5 N when six were added. In eight of the 13 cadaver experiments conducted with four and six EndoStaples, the displacement occurred as a result of complete aortic transection proximal to the fixation site, indicating that aortic tissue integrity was the limiting factor in these experiments.ConclusionsThe fixation of eight different endografts was increased by a mean of 30 N with four Aptus EndoStaples and by a mean of 57 N with six EndoStaples in this model. Endostaples can increase endograft fixation to levels equivalent or superior to that of a hand-sewn anastomosis. The application of six EndoStaples results in aortic tissue failure above the fixation zone, demonstrating fixation strength that exceeds inherent aortic integrity in these cadavers.Clinical RelevanceThe proximal fixation of an endovascular device in the endovascular repair of abdominal aortic aneurysms (EVAR) is of crucial importance to avoid complications such as kinking, migration, and endoleak. This study represents the first attempt to quantify the effect of a new innovative device (Aptus EndoStaples) aimed to enhance endograft fixation. A cadaveric model, which resembles the forces applied onto the endovascular devices in vivo, was chosen to test the effect of the EndoStaples. The results suggest that endograft fixation is significantly better after the application of the EndoStaples, to an extent where it surpasses the inherent durability of the vessel wall

Regional anaesthesia versus general anaesthesia in endovascular aneurysm repair: the surgical nursing interventions

Minimally invasive surgical techniques are a revolutionary and innovative approach to the practice of surgery. Endovascular aneurysm repair (EVAR) may offer a number of significant advantages in comparison with conventional open surgical repair. The purpose of this study was to compare regional anaesthesia (RA) and general anaesthesia (GA) in EVAR, and to describe the surgical nursing interventions. This included a retrospective analysis of 160 consecutive patients (age 55 to 96 years) who underwent EVAR under: epidural anaesthesia (EDA = 60 patients), combined spinal and epidural anaesthesia (Combined = 40 patients) and GA = 60 patients. Results were successful in all patients and no mortality was noticed. Among the GA group, 11 patients needed ICU support while only 5 from the other 2 groups. Furthermore, a statistically significant difference regarding median hospital stay was also noticed in favour of the regional group. In conclusion, RA is a safe and effective anaesthetic method for endovascular repair of abdominal aneurysms, offering several advantages including simplicity, haemodynamic stability, less need for ICU management and reduced hospital stay. The anaesthetic nurse can play a major role in the management of this anaesthesia throughout the procedure

Bilateral giant femoropopliteal artery aneurysms: a case report

<p>Abstract</p> <p>Introduction</p> <p>Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm.</p> <p>Case Presentation</p> <p>We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE) femoropopliteal interposition graft was placed successfully. Management and literature review are discussed.</p> <p>Conclusion</p> <p>We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.</p

Regional Anaesthesia versus General Anaesthesia in Endovascular Aneurysm Repair: The Surgical Nursing Interventions

Minimally invasive surgical techniques are a revolutionary and innovative approach to the practice of surgery. Endovascular aneurysm repair (EVAR) may offer a number of significant advantages in comparison with conventional open surgical repair. The purpose of this study was to compare regional anaesthesia (RA) and general anaesthesia (GA) in EVAR, and to describe the surgical nursing interventions. This included a retrospective analysis of 160 consecutive patients (age 55 to 96 years) who underwent EVAR under: epidural anaesthesia (EDA = 60 patients), combined spinal and epidural anaesthesia (Combined = 40 patients) and GA = 60 patients. Results were successful in all patients and no mortality was noticed. Among the GA group, 11 patients needed ICU support while only 5 from the other 2 groups. Furthermore, a statistically significant difference regarding median hospital stay was also noticed in favour of the regional group. In conclusion, RA is a safe and effective anaesthetic method for endovascular repair of abdominal aneurysms, offering several advantages including simplicity, haemodynamic stability, less need for ICU management and reduced hospital stay. The anaesthetic nurse can play a major role in the management of this anaesthesia throughout the procedure. © 2009, British Association of Anaesthetic and Recovery Nursing. All rights reserved

Cost and effectiveness comparison of endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysm: A single-center experience

The study objective was to compare the cost and effectiveness of two surgical techniques: open repair and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). We assessed 58 surgical operations of AAA repair conducted in 54 men and 4 women (aged 49-94 years) during 2003 and 2004. Open surgical repair was performed in 21 patients, and EVAR was performed in 37 patients. The evaluation of the effectiveness of both methods was based on the following factors: mortality within 30 days, surgery duration, total hospitalization time, and intensive care unit stay duration. The segmental costs of grafts, anesthesia, and extra materials were included in the calculations for the comparison of the costs of the two methods. A 30-day mortality of 5.17% and 0% was demonstrated for open surgical repair and EVAR, respectively. In regard to the operation&apos;s mean duration, this was calculated to 279.52 minutes for open repair and 193.57 minutes for EVAR. The mean duration of the in-hospital stay was 11.3 and 4.09 days for open repair and EVAR, respectively. Accordingly, the mean duration of intensive care unit stay was 2.81 and 0.23 days, respectively. The cost evaluation revealed a mean cost of 5374.3€ ($7,643.49) and 20,592.52€ ($29,287.50) for open repair and EVAR, respectively. Open repair is a &quot;tested method&quot; of its own time. EVAR seems to have the advantage on aspects of effectiveness, yet its major hallmark is its significant cost, as indicated in the relevant part of the current study. © 2008 Society for Vascular Nursing, Inc

Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation

Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved