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      Uso de conductos iliofemorales como medida para reducir la morbimortalidad neurológica y vascular en EVAR complejo Translated title: Use of iliofemoral conduits to reduce neurological and vascular morbimortality associated with complex EVAR

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          Abstract

          Resumen Introducción y objetivo: la enfermedad oclusiva de las arterias ilíacas puede ser causa de complicaciones en EVAR. Su frecuencia no es muy alta, pero su mortalidad sí y hay evidencia escasa en cuanto a su repercusión en EVAR complejo. El uso de conductos iliofemorales es una herramienta que existe para combatir este problema. El objetivo de este trabajo es analizar el impacto del uso de conductos iliofemorales en la morbimortalidad neurológica y vascular en FEVAR y BEVAR. Materiales y métodos: recolección retrospectiva de pacientes con aneurismas yuxtarrenales, abdominotorácicos o endoleak IA tratados mediante FEVAR o BEVAR de forma electiva entre 2014 y 2020 en una sola institución (la Clínica La Sagrada Familia, Buenos Aires, Argentina). Se dividieron en dos grupos: uno, con conductos (grupo A), y otros, sin (grupo B). El grupo A se subdividió entre aquellos con conductos temporales y aquellos con permanentes. Resultados: analizamos 45 pacientes. 23 recibieron conductos (grupo A) y 22, no (grupo B). La edad media fue de 73 años y el diámetro promedio del saco fue de 69,89 mm. La estancia hospitalaria media fue de 4,7 días. El grupo A presentó más pacientes con enfermedad vascular periférica (56,5 % frente a 22,7 %, p = 0,045) y diámetros menores de arterias ilíacas externas. Hubo 8 complicaciones en el perioperatorio (17,8 %; grupo A, n = 1, 4,3 %, frente al grupo B, n = 7, 31,8 %; p = 0,043). Fallecieron 2 pacientes, lo que dejó una mortalidad perioperatoria del 4,4 % (grupo A, 0 %, frente al grupo B, 9,1 %; p = 0,45). Las complicaciones incluyeron isquemia medular, ruptura de la arteria ilíaca e isquemia de miembros inferiores. Dentro del grupo A, 12 pacientes (52,2 %) recibieron conductos permanentes y otros 11 (47,8 %), temporales. Conclusiones: los conductos iliofemorales en FEVAR y BEVAR son seguros cuando forman parte de la planificación preoperatoria. Las complicaciones neurológicas y vasculares no son infrecuentes y conllevan una alta mortalidad. El uso de conductos es efectivo para reducir su incidencia y la mortalidad asociada.

          Translated abstract

          Abstract Introduction and objective: occlusive arterial disease involving the iliac arteries can be cause of complications in EVAR. Its frequency is not high, but its mortality is and there is scant evidence regarding its repercussion in complex EVAR. The use of iliofemoral conduits is a tool to overcome this problem. Our objective is to analyze the impact of the use of iliofemoral conduits in the neurological and vascular morbimortality associated with FEVAR and BEVAR. Materials and methods: retrospective recollection of patients who underwent elective FEVAR or BEVAR for juxtarrenal, thoracoabdominal aneurysms or type IA endoleak between 2014 and 2020 in one institution (Clínica La Sagrada Familia, Buenos Aires, Argentina). Patients were divided in two groups, one with conduits (group A) and one without (group B). Group A was subdivided between those who received temporary conduits and those with permanent conduits. Results: we analyzed 45 patients. 23 received conduits (group A) whereas 22 did not (group B). Mean age was 73 years and mean sac diameter was 69.89 mm. Mean hospital stay was 4.7 days. Group A presented more patients with peripheral vascular disease (56.5 % vs. 22.7 %, p = 0.045) and smaller iliac arteries. There were 8 complications in the perioperative period (17.8 %; group A, n = 1, 4.3 %; group B, n = 7, 31.8 %. p = 0.043). 2 patients died, leaving a perioperative mortality of 4.4 % (group A 0 % vs. group B 9.1 %, p = 0.45). Complications included spinal cord ischemia, iliac artery rupture and lower limb ischemia. In group A, 12 (52.2 %) patients received permanent conduits and 11 (47.8 %) temporary conduits. Conclusions: the use of iliofemoral conduits in FEVAR and BEVAR is safe when they are part of the preoperative planning. Neurological and vascular complications are not infrequent and carry a high mortality. The use of conduits is effective to reduce its incidence and associated mortality.

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          Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair.

          The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (>5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age ≥ 80 years, aortic neck diameter ≥ 28 mm, aortic neck angle >60°, and common iliac artery diameter >20 mm. In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture.
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            Editor's Choice – The Impact of Early Pelvic and Lower Limb Reperfusion and Attentive Peri-operative Management on the Incidence of Spinal Cord Ischemia During Thoracoabdominal Aortic Aneurysm Endovascular Repair

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              Closure of large percutaneous access sites using the Prostar XL Percutaneous Vascular Surgery device.

              To report early experience using a vascular closure device following endovascular aortic aneurysmal repair in which large-bore sheaths are used.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                October 2023
                : 75
                : 5
                : 290-297
                Affiliations
                [1] Buenos Aires orgnameServicio de Cirugía Vascular Periférica. Clínica La Sagrada Familia Argentina
                Article
                S0003-31702023000500003 S0003-3170(23)07500500003
                10.20960/angiologia.00463
                de8d1ad5-7749-4633-b7a9-aaf5ab970b66

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

                History
                : 06 June 2022
                : 17 August 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 8
                Product

                SciELO Spain

                Categories
                Originales

                Conducto iliofemoral,BEVAR,FEVAR,Paraplegia,Complex EVAR,Iliofemoral conduit,Paraplejia,EVAR complejo

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