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This article describes the ESVS practice guidelines for abdominal aortic and iliac aneurysms.
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Background:
Endovascular abdominal aortic aneurysm repair (EVAR) is considered the primary option for abdominal aortic aneurysm but the management of concomitant wide or aneurysmal iliac arteries (CIAs) is still controversial.
Methods:
We retrospectively evaluated mid-term results of patients receiving standard EVAR combined with bell-bottom tec...
An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar a...
Arterial aneurysms are very rare in children, with iliac aneurysms being even more uncommon. We report the case of a 61-day-old girl with a right common iliac artery aneurysm that was an incidental finding on the third day of life. The aneurysm was treated by direct aneurysm puncture and endovascular coil embolization. The patient was discharged wi...
Rationale:
Common iliac artery aneurysm (CIAA) is complicated by ilio-iliac arteriovenous fistulas (IIAVF), which is rare but fatal and require prompt diagnosis and appropriate treatment. As open repair is associated with high morbidity and mortality, endovascular therapy is considered appropriate for treating an IIAVF.
Patient concerns:
A 76-ye...
Considering the recent advancements in endovascular management of aortoiliac aneurysms, the use of an iliac branch device (IBD) to preserve pelvic blood flow and reduce complications caused by embolization of the internal iliac artery (IIA) is recommended by various guidelines. Although the outcomes reported following IBD placement are mainly posit...
Citations
... The primary goal in the management of abdominal aortic aneurysm (AAA) is to prevent rupture, which is reported to have a mortality rate as high as 90 percent. The most critical determinant of rupture risk is the diameter of the aortic aneurysm [1], which is currently the primary criterion for intervention [2]. Large aneurysms (higher than 55 mm), are usually candidates for surgical/endovascular treatment, while smaller aneurysms are treated conservatively with a predefined imaging follow-up program [3]. ...
Background
Vitamins D, E, A, B, C, and Omega-3 play crucial roles in modulating inflammatory and oxidative stress pathways, both implicated in abdominal aortic aneurysm (AAA) development. Recent research has explored the potential impact of dietary supplements on AAA progression. The systematic review aims to assess interventional studies investigating the effects of various dietary supplements on the development and severity of abdominal aortic aneurysms.
Method
A systematic search using relevant keywords related to abdominal aortic aneurysm and dietary supplements was conducted across four databases (PubMed, Embase, Scopus, and Web of Science). Quality assessment for animal studies employed SYRCLE and the Cochrane Collaboration Risk of Bias Tool for randomized control trials. The study protocol is registered in PROSPERO under the registry code CRD42023455958.
Results
Supplementation with Omega-3, Vitamins A, C, D, E, and the Vitamin B family exhibited positive effects in AAA progression. These supplements contributed to a reduction in AAA diameter, elastin degradation, inflammatory responses, and reactive oxygen species. Additional supplements such as Zinc, methionine, and phytoestrogen also played roles in mitigating AAA progression.
Conclusion
The findings of this study underscore the potential role of dietary supplements in the progression of AAA. Predominantly based on animal studies, the results indicate that these supplements can limit AAA progression, primarily evidenced by their ability to mitigate inflammatory processes and oxidative stress pathways.
... 7 For abdominal aortic aneurysm (AAA) a diameter of ≥ 30 mm on imaging is suggested, which is more than two standard deviations above the mean diameter of the aorta in men. 8 There are differences between thoracic and abdominal aorta in terms of histology and pathophysiology of the diseases. The aortic wall consists of three layers: tunica intima, tunica media and tunica adventitia. ...
... Prevalence of AAA has declined during the last 20 years. 8 The global prevalence of AAA was reported as 2.42 % in 1990 and 2.27 % in 2010, with higher prevalence in Australia, Western Europe, North America and with lower prevalence in Central Asia and Latin America. Based on screening population studies a prevalence of 1.7% was reported in Sweden (2006)(2007)(2008)(2009) 15 and 1.3% in UK (2009)(2010)(2011)(2012)(2013). ...
... 20 Based on these the European Society for Vascular Surgery (ESVS) guidelines suggest prophylactic surgery for with aneurysm size ≥55mm for men and ≥50mm for women. 8 The aim of prophylactic treatment is to prevent aneurysm rupture. The annual rupture risk for AAA increases exponentially with increasing size, being 10% for diameter of 50-59 mm, 15% for diameter of 60-69 mm and 30% for diameter >70 mm. ...
... Moreover, the use of selected antihypertensives (particularly beta-blockers and ARBs), low-dose aspirin and statin therapy is recommended by the American Heart Association and American College of Cardiology. 15,16 Treatment with ACE inhibitors or ARBs is beneficial for several conditions. Previous studies have demonstrated that ACE inhibitors are associated with better outcomes in patients with post-myocardial infarction who present with other conditions, such as heart failure, diabetes and chronic kidney disease. ...
... These studies were in line with the recent recommendations of the European Society of Vascular Surgery, suggesting that further cardiac assessment should be reserved only for patients with an acute cardiovascular disease, such as unstable angina, decompensated heart failure, severe valvular disease, and significant arrhythmias. In the absence of these diseases, clinical cardiovascular risk factors and the patient's functional capacity should be evaluated, and invasive coronary angiography should follow the same indications as in a non-surgical setting and not be routinely used for perioperative risk assessment before aortic surgery (23). ...
Objective. To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective. Materials and Methods. After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups accord- ing to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables. Results. According to the variability of two parameters, Stroke Volume Variation and Pulse Pressure Variation, patients were classified as stable or unstable. Unstable patients showed a significant alteration in several hemodynamic indices, in comparison to stable ones. According to the intraoperative monitoring, eight high risk patients could have been sent to an ordinary ward due to their stability, with a reduction in the improper use of CSDU and, consequently, in costs. Conclusions. Hemodynamic monitoring with PRAM can be useful in these patients, both for intraoperative management and for the choice of the more appropriate postoperative setting, possibly reducing the improper use of CSDU for hemodynami- cally stable patients who are judged to be at high risk preoperatively, and re-evaluating low surgical risk patients with an unstable intraoperative pattern, with a possible reduction in costs.
... In-hospital deaths In-hospital mortality 4,16 . Thanks to the advances made in timely diagnosis, the refinement of techniques, and the expansion of highly advanced training programs, the perioperative mortality reported in patients undergoing elective AAA repair is < 5% in European and American series 4,16 . ...
... In-hospital deaths In-hospital mortality 4,16 . Thanks to the advances made in timely diagnosis, the refinement of techniques, and the expansion of highly advanced training programs, the perioperative mortality reported in patients undergoing elective AAA repair is < 5% in European and American series 4,16 . In Mexico, we still have much to do in terms of detection, planning, and execution of these procedures under the best safety conditions possible, as reflected in the still high mortality rate seen in this analysis 15 . ...
... OAR is suitable for patients with a longer life expectancy and lower morbidity rates. Although EVAR has, to some extent, reduced short-term mortality after AAA repair, operated patients experience an increased burden on the aortic vasculature, leading to an elevated risk of death (6). However, surgery has its drawbacks, as it requires complex screening and risk assessment before AAA surgery. ...
Abdominal Aortic Aneurysm (AAA) is a disease characterized by localized dilation of the abdominal aorta, involving multiple factors in its occurrence and development, ultimately leading to vessel rupture and severe bleeding. AAA has a high mortality rate, and there is a lack of targeted therapeutic drugs. Epigenetic regulation plays a crucial role in AAA, and the treatment of AAA in the epigenetic field may involve a series of related genes and pathways. Abnormal expression of these genes may be a key factor in the occurrence of the disease and could potentially serve as promising therapeutic targets. Understanding the epigenetic regulation of AAA is of significant importance in revealing the mechanisms underlying the disease and identifying new therapeutic targets. This knowledge can contribute to offering AAA patients better clinical treatment options beyond surgery. This review systematically explores various aspects of epigenetic regulation in AAA, including DNA methylation, histone modification, non-coding RNA, and RNA modification. The analysis of the roles of these regulatory mechanisms, along with the identification of relevant genes and pathways associated with AAA, is discussed comprehensively. Additionally, a comprehensive discussion is provided on existing treatment strategies and prospects for epigenetics-based treatments, offering insights for future clinical interventions.
... Surveillance techniques are required post-EVAR treatment to follow up with patients during their lifetime. Duplex ultrasound (DUX) is the standard surveillance imaging modality with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) performed at 5 year intervals or earlier if the aortic sac is determined to be growing upon duplex surveillance [6][7][8]. However, these cross-sectional imaging modalities have limitations such as high cost in terms of time and resources (burdening the health system), and in the case of CTA, require the patients to be exposed to ionizing radiation and nephrotoxic contrast agents to obtain a quality image of the aneurysm [8,9]. ...
... The AAA treatment type (open surgery or EVAR) is considered for each patient. Guidelines have been designed to support physicians in carefully formulating a plan of the best treatment option for the patient [6]. The aneurysm treatment is associated with low rates of morbidity and mortality. ...
... The aneurysmal sac is then closed around the graft. The purpose of the graft is to relieve pressure from the weakened aortic wall, which is closed around the graft [6]. Despite the advances in aneurysm repair techniques, mortality following repair remains high, especially in the repair of ruptured aneurysms [2,53]. ...
Over the past two decades, there has been extensive research into surveillance methods for the post-endovascular repair of abdominal aortic aneurysms, highlighting the importance of these technologies in supplementing or even replacing conventional image-screening modalities. This review aims to provide an overview of the current status of alternative surveillance solutions for endovascular aneurysm repair, while also identifying potential aneurysm features that could be used to develop novel monitoring technologies. It offers a comprehensive review of these recent clinical advances, comparing new and standard clinical practices. After introducing the clinical understanding of abdominal aortic aneurysms and exploring current treatment procedures, the paper discusses the current surveillance methods for endovascular repair, contrasting them with recent pressure-sensing technologies. The literature on three commercial pressure-sensing devices for post-endovascular repair surveillance is analyzed. Various pre-clinical and clinical studies assessing the safety and efficacy of these devices are reviewed, providing a comparative summary of their outcomes. The review of the results from pre-clinical and clinical studies suggests a consistent trend of decreased blood pressure in the excluded aneurysm sac post-repair. However, despite successful pressure readings from the aneurysm sac, no strong link has been established to translate these measurements into the presence or absence of endoleaks. Furthermore, the results do not allow for a conclusive determination of ongoing aneurysm sac growth. Consequently, a strong clinical need persists for monitoring endoleaks and aneurysm growth following endovascular repair.
... Current clinical practices widely utilise endovascular aneurysm repair (EVAR) as a viable treatment option. In cases where a patient is not suitable for EVAR, open surgery is necessary to repair the affected artery [8]. EVAR is a minimally invasive procedure that involves placing a graft in the aneurysmal area using a catheter to redirect blood flow through the graft [2,8]. ...
... In cases where a patient is not suitable for EVAR, open surgery is necessary to repair the affected artery [8]. EVAR is a minimally invasive procedure that involves placing a graft in the aneurysmal area using a catheter to redirect blood flow through the graft [2,8]. EVAR offers a survival advantage of the patient's life in the early stages compared to open surgery. ...
Abdominal aortic aneurysm (AAA) is a dilation of the aorta artery larger than its normal diameter (>3 cm). Endovascular aneurysm repair (EVAR) is a minimally invasive treatment option that involves the placement of a graft in the aneurysmal portion of the aorta artery. This treatment requires multiple follow-ups with medical imaging, which is expensive, time-consuming, and resource-demanding for healthcare systems. An alternative solution is the use of wireless implantable sensors (WIMSs) to monitor the growth of the aneurysm. A WIMS capable of monitoring aneurysm size longitudinally could serve as an alternative monitoring approach for post-EVAR patients. This study has developed and characterised a three-coil inductive read-out system to detect variations in the resonance frequency of the novel Z-shaped WIMS implanted within the AAA sac. Specifically, the spacing between the transmitter and the repeater inductors was optimised to maximise the detection of the sensor by the transmitter inductor. Moreover, an experimental evaluation was also performed for different orientations of the transmitter coil with reference to the WIMS. Finally, the FDA-approved material nitinol was used to develop the WIMS, the transmitter, and repeater inductors as a proof of concept for further studies. The findings of the characterisation from the air medium suggest that the read-out system can detect the WIMS up to 5 cm, regardless of the orientation of the Z-shape WIMS, with the detection range increasing as the orientation approaches 0°. This study provides sufficient evidence that the proposed WIMS and the read-out system can be used for AAA expansion over time.
... This occurrence may be a risky condition, and reported cases of iliac rupture during conservative management and poor results after emergency treatment suggest an elective approach [19]. Specific guidelines are absent, but there is agreement about treatment if the sac has expanded >1 cm over the past year or if a 5 mm expansion between two examinations is documented [20]. Past management techniques consisted of open surgery with ligation of the internal iliac artery, but less invasive procedures exist nowadays, so the current strategy reserves traditional surgery as a second option for suitable patients. ...
Late type II endoleaks (T2ELs) arising from the internal iliac artery (IIA) may present during follow-up after endovascular aortic repair (EVAR) of aortoiliac aneurysm and may warrant embolization if enlargement of the aneurysmal sac is demonstrated. When coverage of the IIA ostium has been made due to extensive iliac disease, access options can be challenging. Different treatment options have been reported over recent years, and a careful selection of the best one must be made based on the characteristics of each case. The present study reports a simple and reproducible sheathless percutaneous superior gluteal artery (SGA) access and provides a discussion based on a review of the existing literature on this topic.
... IMH was defined according to European Society Vascular Surgery clinical practice guidelines as the presence of blood within the aortic wall without intimal disruption or an identifiable entry point on imaging (6). PAU was defined as an ulceration of an aortic atherosclerotic plaque penetrating through the internal elastic lamina into the media (7)(8)(9). ...
Background: Lung cancer and aortic disease share multiple risk factors. The co-presence of both diseases
defines a peculiar type of patient who needs a specific protocol of treatment and follow-up. The aim of our
study was to evaluate the prevalence of aortic disease in a population of patients with a diagnosis of primary
lung cancer.
Methods: A retrospective, single center analysis of all patients admitted to the Thoracic Surgery Unit
from January 2015 to January 2021. Demographic and baseline characteristics were retrieved from hospital
electronic charts. All patients were screened for aortic disease, reviewing thoraco-abdominal Computed
Tomography with contrast medium administration performed for oncological reasons. A cancer-free control
group was obtained for comparison. Multilinear regression analysis was performed to identify the risk factors
for the presence of aortic disease.
Results: A total of 264 patients were preliminarily identified. After reviewing for exclusion criteria, a total
of 148 patients were included in the analysis. Most of the patients were male (62.2%) with a mean age of
71±8.7 years. Cardiovascular risk factors were extensively prevalent in the population study. The incidence
of aortic pathologies in the group of patients suffering from primary lung cancer was 27% (40 patients).
The majority presented thoracic aortic aneurysms (11.5%). Comparison between the lung cancer group and
the control group highlighted a substantial difference in terms of aortic disease prevalence (27% vs. 2.9%;
P<0.0001). The regression analysis revealed that coronary artery disease [odds ratio (OR) 4.6988, P=0.001],
peripheral artery disease (OR 7.7093, P=0.002), hypertension (OR 4.0152, P=0.03) and history of previous
non-aortic vascular surgery procedures (OR 6.4509, P=0.003) were risk factors for aortic disease in patients
with primary lung cancer.
Conclusions: Patients with lung cancer have a high prevalence of aortic disease, defining a peculiar subset
of patients who deserve a specific protocol of treatment and follow-up. Further studies are needed to define a
dedicated standardized multidisciplinary approach.
