Current Endovascular Management of Abdominal Aortic Aneurysm

Brown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002;89:714–30. •• Lederle FA: The rise and fall of abdominal aortic aneurysm. Circulation 2011, 24:1097-1099. An author with intimate knowledge in the field discusses recent shifts in the epidemiology of AAA. Lindholt JS, Norman PE. Meta-analysis of postoperative mortality after elective repair of abdominal aortic aneurysms detected by screening. Br J Surg. 2011;98:619–22. Parodi JC, Palmaz JC, Barone BD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–9. Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007;146:735–41. • Greenhalgh RM, Brown LC: The most important misinterpretations of the UK randomised trials on abdominal aortic aneurysm repair. Scand J Surg 2008, 97:116-120. Two of the key investigators from the EVAR-1 and EVAR-2 give a well-written rebuttal to criticisms of the studies. Chambers D, Epstein D, Walker S, et al.: Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model. Health Technol Assess 2009, 13:1-189, 215-318. Ouriel K. The PIVOTAL study: a randomized comparison of endovascular repair versus surveillance in patients with smaller abdominal aortic aneurysms. J Vasc Surg. 2009;49:266–9. • Schanzer A, Greenberg RK, Hevelone N, et al.: Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011, 123:2848-2855. The authors come to the conclusion that over 30% of EVAR performed is outside of the device instructions and relate that finding to complication rates. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2–49. •• Greenhalgh RM, Brown LC, Powell JT, et al.: Endovascular versus open repair of abdominal aortic aneurysm. N Eng J Med 2010, 362:1863-1871. This is an important long-term follow-up from the EVAR-1 trial that gives insight into the natural history of AAA. • Brown LC, Thompson SG, Greenhalgh RM, et al.: Incidence of cardiovascular events and death after open or endovascular repair of abdominal aortic aneurysm in the randomized EVAR trial 1. Br J Surg 2011, 98:935-942. The original investigators examine the progressive loss of short-term survival advantage for EVAR compared to open surgery. Blankensteijn JD, de Jong SE, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Eng J Med. 2005;352:2398–405. • DeBruin JL, Baas AF, Buth J, et al.: Long term outcome of open or endovascular repair of abdominal aortic aneurysm. N Eng J Med 2010, 362:1881-1889. This is the long-term follow-up from the DREAM group. • Becquemin JP, Pillet JC, Lescalie F, et al.: A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg 2011, 53:1167-1173. The ACE trialists share their experience including impressive outcomes for OSR. •• Lederle FA, Freischlag JA, Kyriakides TC, et al.: Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009, 302:1535-1542. This is the interim (short-term) report for the OVER trial involving therapy for large aneurysms. The early survival advantage of endovascular repair is explored. No differences were noted between the two procedures on multiple counts. U.S. Food and Drug Administration: Public Health Notifications (medical devices). Available at http://fda.gov/MedicalDevices/Safety/AlertsandNotices/Public HealthNotifications/ucm062008.htm. Accessed October 2011. Giles KA, Landon BE, Cotterill P, et al. Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg. 2011;53:6–13. Abbruzzese TA, Kwolek CJ, Brewster DC, et al. Outcomes following endovascular aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg. 2008;48:19–28. •• Greenhalgh RM, Brown LC, Powell JT, et al.: Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Eng J Med 2010, 362:1872-1880. This report shares the findings of the EVAR-2 trial. Buckley CJ, Rutherford RB, Diethrich EB, Buckley SD. Inherent problems with randomized clinical trials with observation/no treatment arms. J Vasc Surg. 2010;52:237–41. Sobocinski J, Maurel B, Delsart P, et al. Should we modify our indications after the EVAR-2 trial conclusions? Ann Vasc Surg. 2011;25:590–7. Cuypers P, Buth J, Harris PL, et al.: Reprinted article “Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry”. Eur J Vasc Endovasc Surg 2011, 42 Suppl 1:S63-71. The UK Small Aneurysm Trial Participants: Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Eng J Med 2002, 346:1445-1452. Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437–44. • Ouriel K, Clair DF, Kent KC, et al.: Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg 2010, 51:1081-1087. This study (PIVOTAL) and the CAESAR study below will likely bring the saga of the small AAA to a conclusion. Cao P, De Rango P, Verzini F, et al. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg. 2011;41:13–25. • Jim J, Rubin BG, Geraghty PJ, et al.: Outcome of endovascular repair of small and large abdominal aortic aneurysms. Ann Vasc Surg 2011, 25:306-314. The authors make another convincing argument for observation of small AAA. Mehta M, Sternbach Y, Taggert JB, et al. Long term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg. 2010;52:1442–8. Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the medicare population. N Engl J Med. 2008;358:464–74. Newton III WB, Shukla M, Andrews JS, et al. Outcomes of acute intraoperative surgical conversion during endovascular aortic aneurysm repair. J Vasc Surg. 2011;54:1244–50. Brinster CJ, Fairman RM, Woo EY, et al. Late open conversion and explantation of abdominal aortic stent grafts. J Vasc Surg. 2011;54:42–6. Brown LC, Greenhalgh RM, Powell JT, et al. Use of baseline factors to predict complications and reinterventions after endovascular repair of abdominal aortic aneurysm. Br J Surg. 2010;97:1207–17. Van Marrewijk CJ, Fransen G, Leheij RJ, et al. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcomes of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg. 2004;27:128–37. Jones JE, Atkins MD, Brewster DC, et al. Persistent Type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007;46:1–8. Bade MA, Ohki T, Cynamon J, Veith FJ. Hypogastric artery aneurysm rupture after endovascular graft exclusion with shrinkage of the aneurysm: significance of endotension from a “virtual” or thrombosed type II endoleak. J Vasc Surg. 2001;33:1271–4. • Beeman BR, Murtha K, Doerr K, et al.: Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR. J Vasc Surg 2010, 52:1147-1152. These authors find that prevailing knowledge might not be correct with regard to ultrasound monitoring of AAA. The finding of bidirectional flow is consistent with the process whereby type II endoleaks become persistent. Marchiori A, von Ristow A, Guimaraes M, et al. Predictive factors for the development of Type II Endoleak. J Endovasc Ther. 2011;18:299–305. Keedy AW, Yeh BM, Kohr JR, et al. Evaluation of potential outcome predictors in type II endoleak: a retrospective study with CT angiography feature analysis. AJR Am J Roentgenol. 2011;197:234–40. Dillavou ED, Muluk SC, Rhee RY, et al. Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair? J Vasc Surg. 2003;38:657–63. • Wyss TR, Dick R, Brown LC, Greenhalgh RM: The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair. J Vasc Surg 2011, 54:965-971. Recognition of specific factors that make EVAR more difficult will assist us in making the proper choice for a particular patient. AbuRahma AF, Campbell JE, Mousa AY, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg. 2011;54:13–21. Takagi H, Sugimoto M, Kato T, et al. Postoperative incision hernia in patients with abdominal aortic aneurysm and aortoiliac occlusive disease: a systematic review. Eur J Vasc Endovasc Surg. 2007;33:177–81. Harrison GJ, Oshin OA, Vallabhaneni SR, et al. Surveillance after EVAR based on duplex ultrasound and abdominal radiography. Eur J Vasc Endovasc Surg. 2011;42:187–92. Starnes BW, Quiroga E, Hutter C, et al. Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg. 2010;51:9–17. • Krajcer Z, Nelson P, Bianchi C, et al.: Percutaneous endovascular abdominal aortic aneurysm repair: methods and initial outcomes from the first prospective, multicenter trial. J Cardiovasc Surg (Torino) 2011, 52:651-659. The PEVAR trialists share their initial findings. Malkawi AH, Hinchliffe RJ, Holt PJ, et al. Percutaneous access for endovascular aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg. 2010;39:676–82. Georgiadis GS, Antoniou GA, Papaioakim M, et al. A meta-analysis of outcome after percutaneous endovascular aortic aneurysm repair using different size sheaths or endograft delivery systems. J Endovasc Ther. 2011;18:445–59.