Leonidas Azas

Early and Long-term Results of Conventional Surgical Treatment of Secondary Aorto-enteric Fistula

OBJECTIVE To retrospectively evaluate early and late results of surgical treatment of secondary aorto-enteric fistulas (SAEFs) with prosthetic excision and extra-anatomic bypass (conventional treatment) in a single centre institution (teaching hospital). MATERIALS AND METHODS Between January 1990 and March 2002, 30 patients underwent conventional surgical treatment for SAEF. Data concerning these operations were collected in a dedicate database and 30-day mortality, patency and limb salvage rates were evaluated by mean of chi-square test and logistic regression analysis. Clinical and ultrasonographic follow-up was performed; late results were evaluated by mean of Kaplan-Meyer curves. RESULTS Thirty day mortality rate was 26% (8 patients). Timing and sequence of interventions (simultaneous or staged, prosthetic excision or revascularization before) had no significative influence on perioperative mortality. There were six extranatomic bypass thromboses at 30 days, but no amputation. Mean duration of follow-up was 24 months; estimated 12- and 24-month survival rates were 60 and 50%, respectively. There were better results in terms of long-term survival in patients undergone prosthetic graft excision before. Primary patency rate was 62% and limb salvage rate was 95%, both at 24 months. Two prosthetic graft reinfections occurred during follow-up (9%). Cumulative reinterventions rate during follow-up was 18%. CONCLUSIONS Conventional surgical treatment of SAEF permitted, in our experience, satisfactory early and long terms results, with fair rates of patency and limb salvage. Surgical timing and sequence do not seem to affect early results.

The Treatment of Isolated Iliac Artery Aneurysm in Patients with Non-aneurysmal Aorta

OBJECTIVES The aim of the study was to evaluate early and mid-term results of surgical repair of isolated iliac artery aneurysm (IAA) in patients with non aneurysmal abdominal aorta. METHODS From January 1996 to December 2006, 34 patients with IAA had elective surgery. In 32 cases open repair was performed. Two patients had endovascular repair using a tube endoprosthesis and internal iliac artery coil embolization. The diameters of the abdominal aorta and iliac arteries were measured preoperatively and during follow-up. Early and late results in terms of mortality, major morbidity, reinterventions and graft-related complications were recorded. Mean pre and postoperative diameters of abdominal aorta were compared. RESULTS The site of the IAA was the common iliac artery in 29 cases (10 bilateral), internal iliac artery in 4 cases and external iliac artery in 1 case. Preoperative mean abdominal aortic diameter was 22.2mm (SD 7.6). There were no perioperative deaths and two major complications (retroperitoneal bleeding and limb ischemia) occurred. At the median follow-up time of 24 months survival was estimated as 91%. No reinterventions, graft thrombosis and graft related complications occurred. There were no cases of abdominal aorta aneurysm development. Mean aortic diameter at the most recent imaging was 23.1mm, which was not significantly different from preoperative values (p=0.2). CONCLUSIONS Surgical treatment of IAAs provides good early and mid-term results. During mid-term follow-up the diameter of abdominal aorta remains stable, suggesting IAA may be a localized aneurysmal disease.

Early and Intermediate Results of Elective Endovascular Treatment of True Visceral Artery Aneurysms

BACKGROUND To retrospectively analyze early and follow-up results of endovascular management of visceral artery aneurysms (VAAs) in a single-center experience. METHODS From 2007 to June 2013, 26 consecutive elective endovascular interventions for VAAs were performed in 26 patients; preoperative, intraoperative, and postoperative data were prospectively collected in a dedicated database. Early (<30 days) and follow-up results were evaluated. RESULTS The site of aneurysm was splenic artery in 17 patients, common hepatic artery in 3 patients, renal artery and pancreaticoduodenal artery in 2 cases each, and gastroduodenal artery and celiac trunk in one case each. All the lesions were asymptomatic, and the mean diameter was 22.8 mm. Interventions consisted in coiling in 19 cases; in 4 patients a covered stent was placed, whereas the remaining 3 patients had a multilayer stent. Technical success was 89%. There were no perioperative deaths; 1 patient with splenic artery aneurysm had coils migration with symptomatic splenic infarction and underwent successful redo coils packing. Median duration of follow-up was 18 months. During follow-up, 1 aneurysm-unrelated death occurred. One asymptomatic thrombosis of a treated vessel was recorded, with a 2-year estimated patency rate of 91%. Mean aneurysmal diameter at the latest follow-up was 20.2 mm (P = 0.001 in comparison with preoperative values; 95% confidence interval 1.9-5.2). Complete exclusion of the aneurysm occurred in all but 1 patient, who had a limited increasing in the diameter of its splenic aneurysmal sac after coiling. Another patient developed a more distal aneurysm of the splenic artery after 24 months. No reinterventions were required. Freedom from aneurysm-related complications at 2 years was 72.9% (Standard Error, 0.09). CONCLUSIONS In our experience, endovascular treatment of VAA, when feasible, provided excellent perioperative results with low rates of complications and reinterventions. Even if the risk of developing aneurysm-related complications during follow-up is substantial, most of them can be watched without the need for repeated interventions.

Early and midterm results of kissing stent technique in the management of aortoiliac obstructive disease.

BACKGROUND To retrospectively analyze the early and the midterm results of endovascular management of aortoiliac obstructive disease with the kissing stent technique. METHODS From January 2005 to September 2012, 229 consecutive endovascular interventions for aortoiliac obstructive disease were performed; data from all the interventions were prospectively collected in a dedicated database. In 41 patients, the kissing stent technique at the level of aortic bifurcation was performed (group 1), whereas in the remaining 188 it was not (group 2). Perioperative results were compared with chi-squared test. Follow-up results were analyzed with Kaplan-Meier curves and compared with log-rank test. RESULTS Trans-Atlantic Inter-Society Consensus II C and D lesions were present in 66% of patients in group 1 and in 28.5% in group 2 (P < 0.001), whereas iliac occlusion rather than stenosis was detected in 78% of patients in group 1 and in 50% in group 2 (P = 0.001). The mean number of placed stents was 2.5 in group 1 and 1.4 in group 2 (P < 0.001). Technical success was 100% in group 1 and 98% in group 2 (P = 0.3). The rate of perioperative complications was 7.3% in group 1 and 4.2% in group 2 (P = 0.4). At 30 days, neither deaths nor major cardiovascular complications occurred. There was no thrombosis or significant restenosis at the early postoperative follow-up visit. Mean duration of follow-up was 22 months. Primary patency rates at 4 years were 70.5% (standard error [SE], 0.09) in group 1 and 75.5% (SE, 0.06) in group 2 (P = 0.7). At the same interval, assisted primary and secondary patency and survival rates were also similar; reintervention rates were 15.5% in group 1 (SE, 0.1) and 19.5% in group 2 (SE, 0.06; P = 0.6). CONCLUSIONS The kissing stent technique provided satisfactory results in patients with obstructive aortoiliac diseases, without an increase in immediate and midterm complications, representing an effective solution in complex anatomies.

IF12. The Influence of the Initial Diameter of the Aneurysm on Early and Long-Term Outcomes of Surgical Repair of Popliteal Artery Aneurysms

Objective: Vascular graft infections (VGIs) lead to increased morbidity and mortality, and elderly and comorbid patients are often affected. Negative pressure wound therapy (NPWT) is increasingly used for VGI, and some authors even advocate that a better surgical treatment option is NPWT, débridement, and graft preservation compared with more aggressive approaches in case of VGI with intact anastomosis (Samson III infection). We aimed to assess the effect of NWPT in a large cohort of patients with VGI. Methods: Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) with vascular surgery between March 2013 and March 2017 were included. Observation time was calculated from the end of surgical treatment after diagnosis of VGI to the end of antimicrobial therapy (cure of infection) or last follow-up, whichever occurred first. Patientand procedure-related variables were assessed by NPWT status (yes/no), location of VGI (aortoiliac, thoracic, or infrainguinal), or surgical procedure (débridement and retention of graft; partial or total explantation of graft) using nonparametric tests. We performed Kaplan-Meier curves and univariable and multivariable Cox proportional hazards regression models. Results: A total of 175, predominantly male (77%) patients with a median age of 67 years contributed to the analysis. Thereof, only 15 patients (8.3%) died of VGI after a follow-up time of 2.2 years. A surgical procedure was performed in 145 of 175 (83%) patients. The graft could be retained and débrided in 78 of 145 (54%) patients, whereas 67 (46%) patients had a partial (n 1⁄4 12) or complete graft excision (n 1⁄4 55). NPTW therapy showed an association with cure of infection (Fig) in patients with infrainguinal NPWT treatment (adjusted hazard ratio [aHR], 3.42; 95% confidence interval [CI], 1.37-8.60]; P 1⁄4 .009) and female sex (aHR, 1.74; 95% CI, 1.02-2.97; P 1⁄4 .042). There was no association of cure with NPWT for thoracic (aHR, 0.49; 95% CI, 0.13-1.85; P 1⁄4 .296) or abdominal VGI (aHR, 1.38; 95% CI, 0.57-3.34; P 1⁄4 .471). Conclusions: Multistaged NPWT treatment for downgrading of the infections was associated with a much lower VGI mortality than before.

The increasing role of duplex scanning in the follow-up after endovascular repair of abdominal aortic aneurysms

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Vascular Diagnostics 2014:2 39–45 Journal of Vascular Diagnostics Dovepress