Sabrina Ben Ahmed

Predictive Factors for Type II Endoleaks after Treatment of Abdominal Aortic Aneurysm by Conventional Endovascular Aneurysm Repair.

BACKGROUND The aim of this study was to identify the predictive factors for the development of type II endoleaks (EL-II) after endovascular aneurysm repair (EVAR). METHODS We assessed the preoperative and postoperative computed tomography data of 308 patients who underwent EVAR between 2000 and 2012 and in 84 of whom primary or secondary EL-II occurred. The data analyzed were: demographics, number and diameter of lumbar arteries (LAs), inferior mesenteric artery (IMA), median sacral artery (MSA), accessory renal arteries (ARas), maximum diameter of infrarenal abdominal aortic aneurysm, diameter and length of proximal aortic neck. Statistical analysis was performed using Stata software (version 12). Categorical parameters were compared between groups using chi-squared or Fishers exact tests as appropriate. Continuous variables were analyzed using Students t-test or Mann-Whitney test as appropriate (normality studied by the Shapiro-Wilk and homoscedasticity verified using the Fisher-Snedecor test). RESULTS Of the 308 patients included (mean age, 73.8 ± 8.74 years), 284 (92%) were men, 61 (20%) were smokers, 113 (37%) had chronic obstructive pulmonary disease, 215 (70%) were taking antiplatelet. Respectively, 13, 51, 60, 103, 28, 40, 2, and 7 patients had 1, 2, 3, 4, 5, 6, 7, and 8 patent LAs. Before surgery, 221 IMAs and 136 MSA were patent. The sources of EL-II were: LA (n = 51), IMA (n = 22), MSA (n = 1), IMA and LA (n = 8), IMA and ARa (n = 1), and unknown (n = 1). Logistic regression models adjusting for clinically relevant covariables (age, American Society of Anesthesiologists, smoking status, dyslipidemia, and diuretics) were proposed to study morphologic EL-II predictive factors, first in the entire population, and then in the more specific population for whom IMA was patent. Risk factors of occurrence EL-II were: permeability of the IMA (70 patients [83%] vs. 155 [69%], P = 0.01), IMA diameter (3.49 mm vs. 2.71 mm, P < 0.001), number of LAs patent higher than or equal to 4 (P < 0.001), the mean LA diameter greater than 2.4 mm (P < 0.001), and MSA diameter (2.28 mm vs. 1.94 mm; P < 0.01). CONCLUSIONS Our results show the major role of the number and diameter of the patent aortic branches in the development of EL-II. As they can result in complications increasing the morbidity and mortality after EVAR, it is relevant to identify the risk factors of their occurrence.

Does the technique of carotid endarterectomy determine postoperative hypertension

BACKGROUND Hypertension (HT) after carotid endarterectomy (CEA) is a risk factor for postoperative myocardial infarction, stroke, and neck hematoma. We compared the incidence of postoperative HT within the week after eversion CEA (e-CEA) and patch closure CEA (p-CEA). Postoperative HT was defined as a systolic blood pressure (sBP) ≥ 160 mm Hg and/or the need for postoperative vasodilatators. The aim of our study was to determine if the technique of CEA had an effect on postoperative HT. METHODS Between January 2010 and June 2011, we prospectively reviewed 560 consecutive endarterectomies (340 p-CEAs and 220 e-CEAs) performed in 443 patients under general anesthesia. All had >70% stenoses, 119 were symptomatic, and 441 asymptomatic. We compared preoperative, peroperative, and postoperative sBP and diastolic blood pressure, carotid sinus nerve block, postoperative intravenous and oral antihypertensive medications, neurologic and cardiac complications, and mortality. RESULTS The e-CEA group had a higher incidence of women (36.4% vs. 21.8%, P = 0.0002) and HT (85.0% vs. 78.2%, P = 0.04). The e-CEAs had a significantly higher incidence of carotid sinus nerve block (93.6% vs. 15.6%, P < 0.0001). The incidence of postoperative HT was not significantly different between the 2 groups (75.9% in the e-CEA group versus 68.5% in the p-CEA group, P = 0.06). The average postoperative sBP between postoperative hour (H) 2 and H12 was significantly higher in the e-CEA group but <160 mm Hg. The sBP dropped between H2 and H6, and this decrease was greater in the p-CEA group (30% vs. 15% in the e-CEA group). The need for postoperative antihypertensive medication was not different between the 2 groups. One independent risk factor of postoperative HT was identified: history of HT. The rate of postoperative complications was not significantly different between the 2 groups. CONCLUSIONS The e-CEA technique is not a risk factor and does not have an effect on postoperative HT. The postoperative sBP was more stable in this group. Eversion carotid endarterectomy has been considered, in the literature, as a risk factor of postoperative hypertension. We conducted a large prospective and comparative study of the endarterectomy technique by eversion and with conventional patch closure. The primary end point was the blood pressure value and the administration of antihypertensive treatment. Our study shows that postoperative hypertension after carotid endarterectomy is not related to the surgical technique. Changes in blood pressure after carotid endarterectomy by eversion are lower than those observed after conventional endarterectomy with patch closure. This technique prevents the occurrence of possible hypotension occurrence, which can be the cause of perioperative complications.

Hybrid Treatment of Aortic AneurYsms Associating Bypasses on the Renal/Visceral Arteries and Fenestrated/Branched Stentgrafts: Regional Multicentric Experience

patients. But certain anatomical characteristics of the aorta restrict considerably the feasibility, the effectiveness and the durability of this technique. The technical choice in frail patients presenting anatomical contraindications for endovascular treatment remains debated. The objective of this study was to evaluate the results of open surgery in this category of patients. Materials and Methods: This retrospective study evaluated the results of the conventional scheduled treatment of AAAs in this category of patients between 2004 and 2014 in the regional university hospital. Symptomatic and non-degenerative aneurysms were excluded. 179 consecutive patients aged more than 80 years and/or presenting an ASA score >3 were included. Results: Mean age was 75 years. The average follow-up was 57 months. Mortality at D30 was 2.23%. Survival at five years was 76%. The factors influencing significantly the survival rate at five years were an age >80 years (p1⁄40.04); an increase in serum creatinine>20% at D2 (p1⁄40.02); a preoperative FEV1<80% (p1⁄40.0009). The age>80 years and the increase in creatinine >20% at D2 were significantly predictive of short-term mortality (p1⁄40.0016). Conclusion: These results show an acceptable morbimortality despite the initial frailness of these patients. They justify the place of the conventional surgical treatment of AAAs in these high-risk patients which cannot benefit from endovascular treatment.

Study by Numerical Modeling of the Hemodynamic Impact of the Anatomical Risk Factors of Type B Aortic Dissection

Materials and Methods: Between 2007 and 2015, all the patients treated by TEVAR were re-examined retrospectively, with analysis of the pre and postoperative angioCT. The complications of the PZA are type Ia endoleaks, defect of affixing of at least 20mm, poor positioning of at least 11mm, migration and retrograde dissection. Three types of potential risk factors were analyzed: (1) related to the patients (age, pathology); (2) related to the stentgraft (bare or covered proximal stent, degree of oversizing, number of stents, generation); (3) related to anatomy (PZA and its radius of curvature, diameter, degree of conicity, calcifications and neck thrombus, aortic index of tortuosity (relationship between the lengths of the central line of the aortic arch and the straight line connecting the extreme points of the central line), angle of the zone of anchoring and depth of the arch.

Endovascular Repair of a Short Neck Abdominal Aortic Aneurysm with a Physician-Modified Vascutek Anaconda Stent Graft

An 81-year-old woman was referred for the treatment of a 79-mm-diameter short neck abdominal aortic aneurysm with highly tortuous iliac arteries. She was considered at high risk for open repair and not suitable for standard endovascular repair given the short length of the proximal neck. Delay for a manufactured custom-made fenestrated stent graft was too long given the diameter of the aneurysm. A flexible stent graft was preferred because of severe iliac tortuosity. Endovascular repair was performed using a physician-modified Anaconda stent graft with 1 fenestration for the left renal artery. The technique for device modification and implantation is described. Postoperative course was uneventful and 1-year computed tomography scan showed complete exclusion of the aneurysm sac and patent left renal artery.