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The Frontier of Complex Aortic Aneurysm Repair
“Prospective, nonrandomized study to evaluate endovascular repair of pararenal and thoracoabdominal aortic aneurysm using fenestrated-branched endografts based on supraceliac sealing zones.” Journal of Vascular Surgery, May 2017.
CHICAGO, Illinois, May, 2017 – Significant success has been achieved in treating complex proximal aneurysms using a combination of fenestrated and branched-graft devices, based on a report of prospectively studied patients with complex aortic aneurysm in the May edition of the Journal of Vascular Surgery.
Mayo Clinic researchers led by vascular surgeon Dr. Gustavo Oderich, reported no early mortality, need for permanent dialysis or open conversion, and two patients with paraplegia in their series of 127 patients (including 80 thoracoabdominal aneurysms).
At a follow-up averaging nine months, they had no ruptures or sac enlargement, but there was an 18% need for endovascular re-intervention.
Aortic aneurysm remains a significant cause of mortality and morbidity, particularly in aging patients. While most aneurysms involve the abdominal portion of the aorta (abdominal aortic aneurysm, or AAA), some develop aneurysmal degeneration more proximally involving the paravisceral and thoracic aorta. Repair of these aneurysms, traditionally performed by open surgical approaches, is considerably more complex with increased rates of death, dialysis and paraplegia following repair.
Endovascular therapies for more proximal aortic aneurysm are evolving and mainly involve the use of fenestrated and branched-graft designs. Complications specific to endovascular repair include loss of branch vessel patency (either intra-operative or in follow-up) and endoleak. It is hoped that collaboration between the advanced vascular surgical teams performing these highly complex procedures and companies developing the products used for implantation will continue to drive success for patients with aortic aneurysm.
While these results are outstanding compared to open surgical treatment, Dr. Oderich notes that, “follow-up is still too short to draw any conclusions about time-dependent outcomes, and it is likely that rates of reinterventions, vessel patency and endoleaks will be affected during longer follow-up.”
To download the complete article (open source link ends 5/30/2017), visit: http://vsweb.org/JVS-Frontier
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The Society for Vascular Surgery® (SVS) is a 5,600-member, not-for-profit professional medical society, composed primarily of specialty-trained vascular surgeons, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.
The Journal of Vascular Surgery (JVS) is dedicated to the science and art of vascular surgery and aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. The goal of the journal is to improve the management of patients with vascular diseases by publishing relevant papers that report important medical, surgical and endovascular advances, test new hypotheses and address current controversies.