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1. Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Author

Anna J. Alberga, Jorg L. de Bruin, Frederico Bastos Gonçalves, Eleonora G. Karthaus, Janneke A. Wilschut, Joost A. van Herwaarden, Jan J. Wever, Hence J. M. Verhagen, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Bakker OJ, Balm R, Barendregt WB, Bekken JA, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Blok JJ, Bode AS, Bodegom ME, van der Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Brehm V, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buijs MA, Buimer MG, Burger DH, Buscher HC, Cancrinus E, Castenmiller PH, Cazander G, Coester AM, Cuypers PH, Daemen JH, Dawson I, Dierikx JE, Dijkstra ML, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, Drouven JW, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fokkema TM, Frans FA, Fritschy WM, Fung Kon Jin PH, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hogendoorn W, Hoksbergen AW, Hollander EJ, Hommes M, Hopmans CJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongbloed-Winkel TA, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Koedam NA, Koelemaij MJ, Kolkert JL, Koning GG, Koning OH, Konings R, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laa n MJ, van Laanen JH, van Lammeren GW, Lamprou DA, Lardenoye JH, Lauret GJ, Leenders BJ, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, van de Luijtgaarden KM, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, von Meijenfeldt GC, Menting TP, Metz R, Minnee RC, de Mol van Otterloo JC, Molegraaf MJ, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Noyez VJ, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Post IC, Poyck PP, Prent A, ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, de Ridder JA, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Saleem BR, Salemans PB, van Sambeek MR, Samyn MG, van ‘t Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Scholtes VP, Schouten O, Schreve MA, Schurink GW, Sikkink CJ, te Slaa A, Smeets HJ, Smeets L, Smeets RR, de Smet AA, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, Speijers MJ, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stokmans RA, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Teraa M, Testroote MJ, Tha-In T, The RM, Thijsse WJ, Thomassen I, Tielliu IF, van Tongeren RB, Toorop RJ, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vaes RH, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Velthuis S, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, van der Vijver-Coppen RJ, Visser MJ, van der Vliet JA, Vlijmen—van Keulen CJ, Voorhoeve R, van der Vorst JR, Vos AW, de Vos B, Vos CG, Vos GA, Voute MT, Vriens BH, Vriens PW, de Vries AC, de Vries DK, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van de Water W, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wilschut ED, Wisselink W, Witte ME, Wittens CH, Wong CY, Wouda R, Yazar O, Yeung KK, Zeebregts CJ, van Zeeland ML, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Surgery

Subjects
Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine
Abstract

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data. Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians. Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8–3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2–2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1–3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8–2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4–0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4–0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6–0.8). Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

Published
2022

2. Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

Author

Jalalzadeh H, Indrakusuma R, Koelemay MJW, Balm R, Van den Akker LH, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Baal JG, Bakker OJ, Balm R, Barendregt WB, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Bockel JH, Bodegom ME, Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Breek JC, Brehm V, Brinckman MJ, van den Broek TH, Brom HL, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buimer MG, Burger DH, Buscher HC, den Butter G, Cancrinus E, Castenmiller PH, Cazander G, Coveliers HM, Cuypers PH, Daemen JH, Dawson I, Derom AF, Dijkema AR, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fritschy WM, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hoksbergen AW, Hollander EJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Knippenberg B, Koedam NA, Koelemay MJ, Kolkert JL, Koning GG, Koning OH, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laan MJ, van Laanen JH, Lardenoye JH, Lawson JA, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, Metz R, Minnee RC, de Mol van Otterloo JC, Moll FL, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Peterson TF, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Poyck PP, Prent A, Ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Rupert CG, Saleem BR, van Sambeek MR, Samyn MG, van 't Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Schouten O, Schreinemacher MH, Schreve MA, Schurink GW, Sikkink CJ, Siroen MP, Te Slaa A, Smeets HJ, Smeets L, de Smet AA, de Smit P, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stigter H, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Testroote MJ, The RM, Thijsse WJ, Tielliu IF, van Tongeren RB, Toorop RJ, Tordoir JH, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, Visser MJ, van der Vliet JA, Vlijmen-van Keulen CJ, Voesten HG, Voorhoeve R, Vos AW, de Vos B, Vos GA, Vriens BH, Vriens PW, de Vries AC, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wisselink W, Witte ME, Wittens CH, Wolf-de Jonge IC, Yazar O, Zeebregts CJ, and van Zeeland ML

Subjects
Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures mortality, Endovascular Procedures statistics & numerical data, Female, Guideline Adherence statistics & numerical data, Humans, Iliac Aneurysm epidemiology, Iliac Aneurysm mortality, Iliac Aneurysm pathology, Iliac Artery pathology, Iliac Artery surgery, Male, Netherlands epidemiology, Registries, Retrospective Studies, Sex Factors, Treatment Outcome, Iliac Aneurysm surgery
Abstract

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
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3. A systematic review and meta-analysis of two novel techniques of nonthermal endovenous ablation of the great saphenous vein.

Author

Vos CG, Ünlü Ç, Bosma J, van Vlijmen CJ, de Nie AJ, and Schreve MA

Subjects
Aged, Cyanoacrylates therapeutic use, Endovascular Procedures methods, Epidemiologic Methods, Female, Humans, Male, Tissue Adhesives therapeutic use, Ablation Techniques methods, Saphenous Vein surgery, Venous Insufficiency surgery
Abstract

Background: Endothermal treatment of the great saphenous vein (GSV) has become the first-line treatment for superficial venous reflux. Nonthermal ablation has potential benefits for acceptability by patients and decreased risk of nerve injury. We performed a systematic review and meta-analysis to evaluate the efficacy of mechanochemical endovenous ablation (MOCA) and cyanoacrylate vein ablation (CAVA) for GSV incompetence., Methods: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for papers published between January 1966 and December 2016. Eligible articles were prospective studies that included patients treated for GSV incompetence and described the primary outcome. Exclusion criteria were full text not available, case reports, retrospective studies, small series (n < 10), reviews, abstracts, animal studies, studies of small saphenous vein incompetence, and recurrent GSV incompetence. Primary outcome was anatomic success. Secondary outcomes were initial technical success, Venous Clinical Severity Score, Aberdeen Varicose Vein Questionnaire score, and complications., Results: Fifteen articles met the inclusion criteria. Pooled anatomic success for MOCA and CAVA was 94.7% and 94.8% at 6 months and 94.1% and 89.0% at 1 year, respectively. Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire score significantly improved after treatment with MOCA and CAVA., Conclusions: These results are promising for these novel techniques that could serve as alternatives for thermal ablation techniques. However, to determine their exact role in clinical practice, high-quality randomized controlled trials comparing these novel modalities with well-established techniques are required., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Published
2017
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4. Clarivein mechanochemical ablation of the great and small saphenous vein: Early treatment outcomes of two hospitals.

Author

Deijen CL, Schreve MA, Bosma J, de Nie AJ, Leijdekkers VJ, van den Akker PJ, and Vahl A

Subjects
Adult, Aged, Endothelium, Vascular injuries, Endothelium, Vascular pathology, Female, Humans, Male, Middle Aged, Saphenous Vein pathology, Venous Insufficiency pathology, Ablation Techniques instrumentation, Ablation Techniques methods, Endovascular Procedures instrumentation, Endovascular Procedures methods, Saphenous Vein surgery, Venous Insufficiency surgery
Abstract

Objectives: Mechanochemical endovenous ablation is a novel technique for the treatment of great saphenous vein and small saphenous vein incompetence which combines mechanical injury of the endothelium with simultaneous infusion of liquid sclerosant. The main objective of this study was to evaluate early occlusion., Methods: All consecutive patients who were eligible for the treatment with mechanochemical endovenous ablation were included. Inclusion period was from the introduction of the device in the hospitals (September 2011 and December 2011) until December 2012., Results: A total of 449 patients were included representing 570 incompetent veins. In 506 treated veins, duplex ultrasonography was performed at follow-up: 457 veins (90%) were occluded at a follow-up of 6 to 12 weeks. In univariate and multivariate analysis, failure of treated great saphenous vein was associated with saphenofemoral junction incompetence (OR 4; 95% CI 1.0-17.1, P = 0.049)., Conclusions: The Clarivein device proves to be safe and had a high short-term technical effectiveness., (© The Author(s) 2015.)

Published
2016
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5. A decision aid regarding treatment options for patients with an asymptomatic abdominal aortic aneurysm: a randomised clinical trial.

Author

Knops AM, Goossens A, Ubbink DT, Balm R, Koelemay MJ, Vahl AC, de Nie AJ, van den Akker PJ, Willems MC, Koedam NA, de Haes JC, Bossuyt PM, and Legemate DA

Subjects
Aged, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Abdominal pathology, CD-ROM, Elective Surgical Procedures, Female, Humans, Male, Patient Participation, Patient Satisfaction, Quality of Life, Surveys and Questionnaires, Watchful Waiting, Aortic Aneurysm, Abdominal therapy, Decision Support Techniques, Patient Education as Topic
Abstract

Objective: Abdominal aortic aneurysm patients tend to be informed inconsistently and incompletely about their disorder and the treatment options open to them. The objective of this trial was to evaluate whether these patients are better informed and experience less decisional conflict regarding their treatment options after viewing a decision aid., Design: A six-centre, randomised clinical trial comparing a decision aid plus regular information versus regular information from the surgeon., Methods: Included patients had recently been diagnosed with an asymptomatic abdominal aortic aneurysm at least 4 cm in diameter. The decision aid consisted of a one-time viewing of an interactive CD-ROM elaborating on elective surgery versus watchful waiting. Generally, the decision aid advised patients with aneurysms less than 5.5 cm to agree to watchful waiting, for larger aneurysms the decision aid provided insight into the balance of benefit and harm of surgical and conservative approaches, taking into account age, co-morbidity and size of the aneurysm. The primary outcome was patient decisional conflict measured at 1 month follow-up (Decisional Conflict Scale). Secondary outcomes were patient knowledge, anxiety and satisfaction., Results: In 178 aneurysm patients, decisional conflict scores did not differ significantly between the decision aid and the regular information groups (22 vs. 24 on the 0-100 Decisional Conflict Scale; p = .33). Patients in the decision aid group had significantly better knowledge (10.0 vs. 9.4 out of 13 points; p = .04), whereas anxiety levels (4.4 and 5.0 on a 0-21 scale; p = .73) and satisfaction scores (74 and 73 on a 0-100 scale; p = .81) were similar in both groups., Conclusion: In addition to regular patient-surgeon communication, a decision aid helps to share treatment decisions with abdominal aortic aneurysm patients by increasing their knowledge about the disorder and available treatment options without raising anxiety levels; however, it does not reduce decisional conflict, nor does it improve satisfaction., (Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2014
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6. Cerebral blood flow in relation to contralateral carotid disease, an MRA and TCD study.

Author

de Nie AJ, Blankensteijn JD, Visser GH, van der Grond J, and Eikelboom BC

Subjects
Adult, Aged, Aged, 80 and over, Blood Flow Velocity, Carotid Artery, Internal physiopathology, Carotid Stenosis diagnosis, Carotid Stenosis diagnostic imaging, Cerebral Arteries diagnostic imaging, Cerebral Arteries physiopathology, Collateral Circulation, Female, Humans, Male, Middle Aged, Regional Blood Flow, Statistics, Nonparametric, Carotid Stenosis physiopathology, Cerebrovascular Circulation, Magnetic Resonance Angiography, Ultrasonography, Doppler, Transcranial
Abstract

Objective: to describe redistribution of cerebral blood flow in patients with severe internal carotid artery (ICA) stenoses in relation to contralateral ICA disease., Methods: sixty-six patients scheduled for carotid endarterectomy (CEA) were grouped according to severity of contralateral stenosis (<30% [group I]; 30-69% [group II]; 70-99% [group III]; occlusion [group IV]. Transcranial Doppler (TCD) and magnetic resonance angiography (MRA) investigations were performed preoperatively., Results: TCD demonstrated a reversed flow in the contralateral anterior cerebral artery (A(1)segment) and ophthalmic artery in three-quarters of group IV patients (p <0.0001). Group IV patients also exhibited decreased blood flow velocity in the contralateral middle cerebral artery (p =0.001). MRA showed increased ipsilateral ICA and basilar artery (BA) blood flow volumes (Q-flows) in group IV patients when compared to the other groups (p <0.001). No changes in total Q-flow (ICAs+BA) were found., Conclusions: in patients considered for CEA, the severity of the contralateral ICA disease is an important determinant of the pattern of blood flow redistribution through the anterior communicating pathway and ophthalmic artery. Significant flow redistribution through the posterior communicating pathway occurs especially in patients with contralateral ICA occlusion., (Copyright 2001 Harcourt Publishers Limited.)

Published
2001
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7. Dilatation of the proximal neck of infrarenal aortic aneurysms after endovascular AAA repair.

Author

Wever JJ, de Nie AJ, Blankensteijn JD, Broeders IA, Mali WP, and Eikelboom BC

Subjects
Aged, Angiography, Aortic Aneurysm, Abdominal diagnostic imaging, Dilatation, Pathologic, Female, Follow-Up Studies, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Prospective Studies, Statistics, Nonparametric, Stents, Tomography, X-Ray Computed, Aorta, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation
Abstract

Objectives: to assess size changes of the proximal aortic neck after endograft placement., Methods: since 1994, 54 consecutive patients have undergone abdominal aortic aneurysm (AAA) repair with the Endovascular Technologies (EVT) endograft. The study group comprised the 33 patients who had completed at least six months of the prospective follow-up protocol. The pre-, postoperative and follow-up helical computed tomography (CT) angiograms (CTAs) were processed on a workstation. The proximal neck dimensions were measured perpendicular to the central lumen line of the aortic neck. The cross-sectional area was measured at the proximal attachment system and at 1 cm proximal to the renal arteries., Results: while the dimensions of suprarenal aorta did not change, a significant dilatation of the proximal neck was found. The median increase was 10.3% at 6 months and 15.5% at 12 months. No correlation could be found between the amount of dilatation and pre- or postoperative neck-size, graft diameter and amount of graft-oversizing., Conclusion: the infrarenal aortic neck demonstrates continued dilatation during follow-up after endograft placement., (Copyright 2000 Harcourt Publishers Ltd.)

Published
2000
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