Risk assessment of the development of the endoleak after evar.

Authors

DOI:

https://doi.org/10.26641/1997-9665.2018.4.12-23

Keywords:

infrarenal aortic aneurysm, EVAR, endoleaks

Abstract

Background. Treatment of aortic aneurysms is one of the most difficult problems in angiology. The ending of the development of the disease is the rupture of the aneurysm with high mortality. EVAR is a minimally invasive method of treating aneurysms. However, even today its high immediate effectiveness is leveled by an increased need for repeated interventions in the long-term period. The main cause of repeated interventions is endoleaks of blood in the aneurysmal sac (AS), which causes its increase and the risk of rupture. Objective. Develop methods for predicting the risk of EF after endoprosthetics of the infrarenal aorta by analyzing the results of the study of the morphology of the anterior wall of the common femoral artery (CFA). In the course of the study, an original method for the in vivo diagnosis and prognosis of the pathological process in the aortic wall with its aneurysmal lesion was developed and used, including the taking of material during endoprosthesis. The method differs in that in order to determine pathomorphology, in order to establish the etiology of the development of an aortic aneurysm, a histological study is carried out not directly on the aortic wall, but on the CFA wall, as a large elastic artery. Morphological investigations of CFA were performed in 38 patients. The average age of patients was 66.1 ± 2.1, among them 2 women and 36 men. Results. The results showed that in 22 cases (57.8%) there were direct signs of atherosclerosis, in 14 cases (36.8%) - manifestations of dystrophic changes, in 2 cases (5.26%) inflammatory reactions prevailed in the pattern of pathology. Statistical analysis showed that there is a stable and reliable relationship between the nature of the morphological changes in the wall of the CFA and the dynamics of the AS size after EVAR. Atherosclerotic changes are characterized by a decrease in AS in 77.7%, while with dystrophic changes, a decrease in AM is observed only in 28.7%, and in 64.2% there are no changes in the size of the bag, or the bag has increased. Conclusion. Morphological studies of the CFA wall in patients make it possible to judge that with the prevailing atherosclerotic changes in the vessel walls by 16.5 times - OR-16.5 (2.79-97.68) increases the probability of AS decrease after endoprosthesis replacement. In case of dystrophic changes, the prognostic assessment is unfavorable - the probability of decreasing AS decreases by 94% - OR = 0.06 (0.01-0.36).

References

  1. Guirguis EM, Barber GG. The natural history of abdominal aortic aneurysms. Am J Surg. 1991;162(5):481-3.
  2. Maras D, Lioupis C, Moulakakis KG. Giant abdominal aortic aneurysms: clinical and technical considerations. Acta Chir Belg. 2009;109(3):376–80.
  3. Nikulnikov PI, Vlaikov GG, Gooch AA, Furkalo SN, Mazur AP, Dubovich TN, Ratushnyuk VT, Liksunov OB. [New technologies in the diagnosis and surgical treatment of abdominal aortic aneurysm]. Clinical surgery. 2006;6:66–74. Russian.
  4. Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, von Allmen RS, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. European Heart Journal Advance Access. 2014.
  5. Gillum RF. Epidemiology of aortic aneurysm in the United States. Clin J. Epidemiol. 1995;48:1289–98.
  6. Wilmink AB, Quick CR. Epidemiology and potential for prevention of abdominal aortic aneurysm. Br J Surg. 1998;85(2):155-62.
  7. Nikulnikov PI, Liksunov AV, Ratushnyuk AV, Vlaykov GG, Nagrebetsky AA, Severin VL. [Surgical treatment of abdominal aortic aneurysm rupture]. Actual problems of medical medicine. 2009;9(1):318–20. Ukrainian.
  8. Daly KJ, Torella F, Ashleigh R, McCollum CN. Screening, diagnosis and advances in aortic aneurysm surgery. Gerontology. 2004;50(6):349-59.
  9. Lederle FA, Johnson GR, Wilson SE. The Aneurysm Detection and Management Study Screening ProgramValidation Cohort and Final Results. Arch Intern Med. 2000;160(10):1425-30.
  10. Robinson WP, Schanzer A, Aiello FA, Flahive J, Simons JP, Doucet DR, Arous E, Messina LM. Endovascular repair of ruptured abdominal aortic aneurysms does not reduce later mortality compared with open repair. J Vasc Surg. 2016;63(3):617-24.
  11. Gomolyako ІВ, Nіkulnіkov І, Lіksunov OV, Dubovich TO, Klochkova NЄ, Ratushnyuk AV. [Status of the system of granulocytes as a risk factor for postoperative complications in abdominal aortic aneurysms]. Heart and blood vessels. 2015;3:80-5. Ukrainian.
  12. De Martino RR, Goodney PP, Nolan BW, Robinson WP, Farber A, Patel VI, Stone DH, Cronewett JL. Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. J Vasc Surg. 2013;58(3): 589–95.
  13. Drury D, Michaels JA, Jones L. et al. Systematic review of recent evidence for safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. Br. J. Surg. 2005;92:937–46.
  14. Greenhalgh RM, Brown LC, Powell JT. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1863–71.
  15. Ali MM, Flahive J, Schanzer A, Simons JP, Aiello FA, Doucet DR, Messina LM, Robinson WP. In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. J Vasc Surg. 2015;61(6):1399-407.
  16. Arko FR. Considerations Beyond Anatomy to Best Manage Aortic Disease: The Benefits of EndoAnchors. Endovascular Today. 2016;11-5.
  17. Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100(7).
  18. Atwal G, Wylie S. Anaesthesia for endovascular aortic aneurysm repair (EVAR). Anaesthesia tutorial of the week 303.
  19. Schanzer A, Messina L. Two decades of endovascular abdominal aortic aneurysm repair: enormous progress with serious lessons learned. J Am Heart Assoc. 2012;1:e000075.
  20. Al-Jubouri M, Comerota AJ, MD, Subhash Thakur, MD, Faisal Aziz, MD, Steven Wanjiku, MSC, David Paolini, MD, John P. Pigott, MD, and Fedor Lurie, MD, PhD. Reintervention after EVAR and Open Surgical Repair of AAA. A 15-Year Experience. Annals of Surgery. 2013;258(4):652-8.
  21. Dangas G, O'Connor D, Firwana B, Brar S, Ellozy S. Open versus endovascular stent graft repair of abdominal aortic aneurysms: a meta-analysis of randomized trials. JACC. Cardiovascular interventions 2012:5:1071-80.
  22. De la Motte L, Falkenberg M, Koelemay MJ, Lönn L. Is EVAR a durable solution: indications for re-interventions. J Cardiovasc Surg. 2018.
  23. Nordon IM, Karthikesalingam A, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg. 2010;39(5):547-54.
  24. Goyal A, Keramati AR, Czarny MJ, Resar JR, Mani A. The Genetics of Aortopathies in Clinical Cardiology. Clin Med Insights Cardiol. 2017;11:1179546817709787.
  25. Abdul-Hussien H, Hanemaaijer R, Kleemann R, Verhaaren BF, van Bockel JH, Lindeman JH. The pathophysiology of abdominal aortic aneurysm growth: corresponding and discordant inflammatory and proteolytic processes in abdominal aortic and popliteal artery aneurysms. J Vasc Surg. 2010;51(6):1479-87.
  26. Tuveson V, Löfdahl HE, Hultgren R. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms. Vasc Med. 2016;21(4):369-75.
  27. De Basso R, Sandgren T, Ahlgren ÅR, Länne T. Increased cardiovascular risk without generalized arterial dilating diathesis in persons who do not have abdominal aortic aneurysm but who are first-degree relatives of abdominal aortic aneurysm patients. Clin Exp Pharmacol Physiol. 2015;42(6):576-81.
  28. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2000;31(5):863-9.
  29. Zakharova VP, Rudenko EV, Sitar L, Kravchenko IN, Poliaunova VV. Intimal aortic wall hyperplasia phenomenon at aortic ascending. Cardiovascular surgery. 2013;21:121-4.
  30. De Basso R, Sandgren T, Ahlgren ÅR, Länne T. Increased cardiovascular risk without generalized arterial dilating diathesis in persons who do not have abdominal aortic aneurysm but who are first-degree relatives of abdominal aortic aneurysm patients. Clin Exp Pharmacol Physiol. 2015;42(6):576-81.
  31. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2000;31(5):863-9.

Downloads

How to Cite

Vlasenko O. А. (2018). Risk assessment of the development of the endoleak after evar. Морфологія / Morphologia / Morfologìâ, 12(4), 12–23. https://doi.org/10.26641/1997-9665.2018.4.12-23

Issue

Vol. 12 No. 4 (2018)

Section

Статті

License

Copyright (c) 2018 Vlasenko O.А., Morphologia

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

 The authors reserve the right to authorship of their work and transfer to the Journal the right to the first publication of this work under the terms of a license Creative commons Attribution 4.0 International (CC BY 4.0), which allows other people to freely distribute the published work with a mandatory reference to the authors of the original work and the first publication of the work in this journal.
        By submitting a manuscript to the editorial office of the Journal ‘Morphologia’ authors agree to transfer the rights to protect and use the manuscript (all supplemental materials, particularly protected objects such as photos, drawings, diagrams, tables, etc.), including the reproduction in the press and distribution via the Internet; translation of the manuscript into any language; export and import of journal copies with the Authors’ article in order to make it available for public. Authors convey the rights mentioned above to the editorial office without any temporal or territorial limitation all over the world. 
        The Authors guarantee that they have the exclusive rights to use the material transferred to editorial office. Editors are not responsible to third parties for contraventions of warranty given by the Authors. The considered rights are transferred to the editorial office since the moment when the current issue is signed for publishing. Reproduction of materials published in the Journal by other individuals and legal entities is possible only with the consent of Editorial office, with the obligatory indication of the full bibliographic reference of the primary publication. The Authors reserve the right to use the published material, its fragments and parts for teaching materials, oral presentations, dissertation thesis prepararion with obligatory bibliographic citation of the original paper. Electron copy of the published article, downloaded from official journal web-site in .pdf format may be put by authors on the official web-site of their institutions, any other official resources with open access.