Transradial approach for the endovascular treatment of type I endoleak after aortic aneurysm repair: a case report

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Abstract

Background

Endovascular repair of aortic aneurysms (EVAR) is obtained through the positioning of an aortic stent-graft, which excludes the aneurysmatic dilation. Type I endoleak is the most common complication, and it is caused by an incompetent proximal or distal attachment site, causing the separation between the stent-graft and the native arterial wall, and in turn creating direct communication between the aneurysm sac and the systemic arterial circulation. Endoleak occurrence is associated with high intrasac pressures, and requires a quick repair to prevent abdominal aortic aneurysm rupture.

Case presentation

We report the first case of a 80-year-old man undergoing percutaneous closure of a peri-graft endoleak (type I) by transcatheter embolization through radial arterial access.

Conclusion

The transradial approach has been shown to be a safe and effective alternative to the traditional transfemoral approach. A decrease in vascular complications and improved patient comfort are the primary benefits of this technique in patients with previous EVAR.

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Most cited references 27

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Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.

J C Parodi, J Palmaz, H D Barone (1991)

This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site in the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.

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Screening for abdominal aortic aneurysms: single centre randomised controlled trial.

Jes Lindholt, Magnus Fasting, Steen W Henneberg … (2005)

To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. Single centre randomised controlled trial. All five hospitals in Viborg County, Denmark. All 12,639 men born during 1921-33 and living in Viborg County. In 1994 we included men born 1921-9 (64-73 years). We also included men who became 65 during 1995-8. Men were randomised to the intervention group (screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans. Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms. 4860 of 6333 men were screened (attendance rate 76.6%). 191 (4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 51% to 91%) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84%). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8%. The benefits of screening may increase with time. Mass screening for abdominal aortic aneurysms in Danish men aged 65 or more reduces mortality.

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Inhibition of class I histone deacetylase with an apicidin derivative prevents cardiac hypertrophy and failure.

S. Grimaldi, Christian Steinkühler, Francesco Borgia … (2008)

Recent studies have demonstrated the importance of chromatin remodelling via histone acetylation/deacetylation for the control of cardiac gene expression. Specific histone deacetylases (HDACs) can, in fact, play a positive or negative role in determining cardiac myocyte (CM) size. Here, we report on the effect on hypertrophy development of three inhibitors (HDACi) of class I HDACs. The compounds were first analysed in vitro by scoring hypertrophy, expression of foetal genes, and apoptosis of neonatal rat CMs stimulated with phenylephrine, an alpha1-adrenergic agonist. This initial screening indicated that a truncated derivative of apicidin with class I HDAC specificity, denoted API-D, had the highest efficacy to toxicity ratio, and was thus selected for further analysis in vivo. Administration of this drug significantly decreased myocardial hypertrophy and foetal gene expression after 1 week of pressure overload induced by thoracic aortic constriction (TAC) in mice. After 9 weeks of TAC, when manifest heart failure is encountered, mice treated with API-D presented with significantly improved echocardiographic and haemodynamic parameters of cardiac function when compared with untreated TAC-operated mice. The apicidin derivative, API-D, is capable of reducing hypertrophy and, consequently, the transition to heart failure in mice subjected to TAC. Treatment with this substance, therefore, holds promise as an important therapeutic option for heart failure.

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Author and article information

Contributors

Gabriele Giacomo Schiattarella

Fabio Magliulo

Flora Ilaria Laurino

Roberta Bottino

Antonio Giulio Bruno

Michele De Paulis

Antonio Sorropago

Cinzia Perrino

Bruno Amato

Dario Leosco

Bruno Trimarco

Giovanni Esposito

Conference

Journal ID (nlm-ta): BMC Surg

Journal ID (iso-abbrev): BMC Surg

Title: BMC Surgery

Publisher: BioMed Central

ISSN (Electronic): 1471-2482

Publication date Collection: 2013

Publication date (Electronic): 8 October 2013

Volume: 13

Issue: Suppl 2

Page: S47

Affiliations

[1 ]Department of Advanced Biomedical Sciences, Federico II University, via Pansini 5, 80131 Naples; Italy

[2 ]Department of Clinical Medicine and Surgery, Federico II University, via Pansini 5, 80131 Naples, Italy

[3 ]Department of Translational Medical Sciences, Federico II University, via Pansini 5, 80131 Naples, Itlay

Article

Publisher ID: 1471-2482-13-S2-S47

DOI: 10.1186/1471-2482-13-S2-S47

PMC ID: 3851154

PubMed ID: 24267381

SO-VID: 952fabd3-79c6-40d1-b5c0-63ad1c580f78

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Conference name: 26th National Congress of the Italian Society of Geriatric Surgery

Transradial approach for the endovascular treatment of type I endoleak after aortic aneurysm repair: a case report

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Abstract

Background

Case presentation

Conclusion

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Most cited references 27

Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.

Screening for abdominal aortic aneurysms: single centre randomised controlled trial.

Inhibition of class I histone deacetylase with an apicidin derivative prevents cardiac hypertrophy and failure.

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