nach oben

Current Cardiology Reports

Erschienen in:

01.09.2018 | Peripheral Vascular Disease (CJ Cooper and R Gupta, Section Editors)

Percutaneous Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm

verfasst von: Christopher M. Huff, Mitchell J. Silver, Gary M. Ansel

Erschienen in: Current Cardiology Reports | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

This review discusses the benefits of a completely percutaneous approach to endovascular aortic aneurysm repair (EVAR), and provides an outline as to how this is performed by a multidisciplinary team of cardiologists and cardiovascular surgeons at a quaternary care community hospital.

Recent Findings

Percutaneous endovascular aortic aneurysm repair (PEVAR) as compared to EVAR utilizing surgical femoral artery exposure is associated with a significant reduction in operation time, length of stay, access site complications, patient discomfort, and procedural cost. Furthermore, PEVAR may be the preferred approach in patients presenting with aneurysm rupture, as the avoidance of general anesthesia has been associated with improved 30-day mortality.

Summary

Assuming no contraindication based on vascular anatomy, clinical status, or patient preference, these findings suggest that in properly selected patients, PEVAR should be the primary method for abdominal aortic aneurysm repair in both stable and unstable patients.

National Center for Health Statistics (2016) Underlying cause of death 1999-2015. In: CDC WONDER online database. https://wonder.cdc.gov/wonder/help/ucd.html#.

National Center for Health Statistics (2014) Deaths, percent of total deaths, and death rates for the 15 leading causes of death in selected age groups, by race and sex: United States, 2014. In: Centers dis. Control prev. https://www.cdc.gov/nchs/data/dvs/lcwk1_2014.pdf%0A https://www.cdc.gov/nchs/nvss/mortality/lcwk2.htm.

Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67:2–77.e2.CrossRefPubMed

Von Allmen R, Powell J. The management of ruptured abdominal aortic aneurysms: screening for abdominal aortic aneurysm and incidence of rupture. J Cardiovasc Surg. 2012;53:69–76.

EVAR. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365:2179–86.CrossRef

EVAR. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365:2187–92.CrossRef

Tadros RO, Faries PL, Ellozy SH, Lookstein RA, Vouyouka AG, Schrier R, et al. The impact of stent graft evolution on the results of endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2014;59:1518–27.CrossRefPubMed

Dua A, Upchurch GR, Lee JT, Eidt J, Desai SS. Predicted shortfall in open aneurysm experience for vascular surgery trainees. J Vasc Surg. 2014;60:945–9.CrossRefPubMed

Clough RE, Hertault A, Azzaoui R, Sobocinski J, Haulon S. Low-profile EVAR. Endovasc Today. 2016;15:72–4.

10.

Fanelli F. Has the percutaneous approach for EVAR reduced access site complications? Cardiovasc Intervent Radiol. 2013;36:S98–9.

11.

Nelson PR. Percutaneous endovascular aortic aneurysm repair (PEVAR): results from the first prospective, multicenter randomized trial. J Vasc Surg. 2012;56:1816.CrossRef

12.

•• Buck DB, Karthaus EG, Soden PA, Ultee KHJ, Van Herwaarden JA, Moll FL, et al. Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg. 2015;62:16–21. Retrospective review of 4112 patients undergoing PEVAR vs EVAR via surgical femoral artery exposure. PEVAR was associated with shorter operation time, shorter length of stay, and a reduction in access site complications. CrossRefPubMedPubMedCentral

13.

Agrusa CJ, Meltzer AJ, Schneider DB, Connolly PH. Safety and effectiveness of a “percutaneous-first” approach to endovascular aortic aneurysm repair. Ann Vasc Surg. 2017;43:79–84.CrossRefPubMed

14.

Newman AB, Arnold AM, Burke GL, O’Leary DH, Manolio TA. Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography: the cardiovascular health study. Ann Intern Med. 2001;134:182–90.CrossRefPubMed

15.

Durieux R, Van Damme H, Labropoulos N, Yazici A, Legrand V, Albert A, et al. High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease. Eur J Vasc Endovasc Surg. 2014;47:273–8.CrossRefPubMed

16.

Chavan A, Thomas RP, Dapunt O. Trials update for elective and emergency EVAR. Cardiovasc Intervent Radiol. 2013;36:S100–1.

17.

Hinchliffe RJ, Powell JT, Veith FJ, Rockman C (2015) What does the current evidence on EVAR for ruptured AAA tell us? Endovasc TODAY 65–70.

18.

Stroupe KT, Lederle FA, Matsumura JS, Kyriakides TC, Jonk YC, Ge L, et al. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial. J Vasc Surg. 2012;56:901–909.e2.CrossRefPubMed

19.

Burgers LT, Vahl AC, Severens JL, Wiersema AM, Cuypers PWM, Verhagen HJM, et al. Cost-effectiveness of elective endovascular aneurysm repair versus open surgical repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2016;52:29–40.CrossRefPubMed

20.

• Uhlmann ME, Walter C, Taher F, Plimon M, Falkensammer J, Assadian A. Successful percutaneous access for endovascular aneurysm repair is significantly cheaper than femoral cutdown in a prospective randomized trial. J Vasc Surg. 2018;68(2):384–391. A randomized, prospective study demonstrating the cost-effectiveness of PEVAR when compared to EVAR utilizing surgical femoral artery exposure.

Titel: Percutaneous Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm
verfasst von: Christopher M. Huff
Mitchell J. Silver
Gary M. Ansel
Publikationsdatum: 01.09.2018
Verlag: Springer US
Erschienen in: Current Cardiology Reports / Ausgabe 9/2018
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-018-1023-6

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Percutaneous Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm