Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Is EVAR a durable solution? Indications for reinterventions

Publikation: Bidrag til tidsskriftReviewForskningpeer review

  1. Expanding the indications for transcatheter aortic valve implantation: is it time to treat low risk patients?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Anatomical challenges for transcatheter mitral valve intervention

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. The management of ruptured abdominal aortic aneurysms

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Influence of gender on EVAR outcomes with new low-profile devices

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  5. Are there fewer complications with third generation endografts in endovascular aneurysm repair?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review

    Publikation: Bidrag til tidsskriftReviewForskningpeer review

  2. Flow Complexity Estimation in Dysfunctional Arteriovenous Dialysis Fistulas using Vector Flow Imaging

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review

    Publikation: Bidrag til tidsskriftReviewForskningpeer review

Vis graf over relationer

INTRODUCION: Indications for reinterventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, postprocedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on reinterventions after elective EVAR.

EVIDENCE ACQUISITION: Qualitative review of studies reporting on reinterventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASE and the Cochrane Library for publications from 2010 to 13th of November 2017.

EVIDENCE SYNTHESIS: Twenty-three studies reporting on 83,307 patients met the inclusion criteria. Index procedures were performed between 1996-2014. There was wide heterogeneity in reporting standards. Type I endoleaks were reported in 0.6%-13% and type III endoleaks in 0.9-2.1% with a significant improvement for newer devices. Migration rates varied between 0-4%. Endoleak type II was the most common indication for re-intervention ranging from 14-25.3% although the majority resolved without intervention. Rupture rates ranged from 0-5.4% and carried a high mortality (60-67%). Ruptures occurred at any time after the index procedure. Limb ischemia rates were reported at 0.4-11.9% with re-intervention rates between 0.06-11.9%. Wound related complications and related re-interventions were the indication in 0.5-14% and 0.3-6.5%, respectively. Endograft infection carried a high risk of mortality and was described in 0.3-3.6%, often related to graft-enteric fistula and the majority had an open explantation of the endograft.

CONCLUSIONS: This review showed that the rates of complications and techniques for reintervention developed over time with a tendency towards better outcomes considering the aneurysm related indications. Significant factors that led to subsequent secondary interventions were migration, rupture, infections and type I and II endoleaks. Patients treated with earlier generation endografts are still alive and need continued surveillance to detect these severe complications before they lead to rupture.

OriginalsprogEngelsk
TidsskriftJournal of Cardiovascular Surgery
Vol/bind59
Udgave nummer2
Sider (fra-til)201-212
Antal sider12
ISSN0021-9509
DOI
StatusUdgivet - apr. 2018

ID: 55516308