The use of endovascular aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms is widely spread, due to its minimally invasive approach, rapid recovery, and better short-term survival. Approximately 60% of all infrarenal abdominal aortic aneurysms (AAAs) repairs in Europe and 85% in the United States are by EVAR. A decade ago, we believed...
Cost-Effectiveness of Frenestrated or Branched Endoprostheses vs. Open Surgery
Fenestrated of branched endoprostheses are appealing options for the repair of anatomically-complex aortic aneurysms. Their use is limited by their cost (which is high for everyone, everywhere) and also by the lack of a head-to-head study showing best results than open surgery. This work offers results at 2 years for these devices, including an economic assessment...
Surprisingly, some patients won’t do as told and have less events
Today endovascular aneurysm repair (EVAR) is the preferred option to treat patients with abdominal aortic aneurysms, even though studies have shown reintervention rate is around 20% at 5 years. Consequently, guidelines recommend life EVAR surveillance imaging to identify and treat eventual leaks and prevent aneurysms from growing and eventually rupturing. There are several population and observational studies...
On Radiation Protection: Editorial comment by Dr. Ariel Durán
Courtesy of Dr. Ariel Durán. I am pleased to witness the increased amount of scientific papers in high impact journals addressing topics related to radiation protection or the harmful effects of radiation on our patients and primary or secondary operators. Similarly, it is my pleasure to see that SOLACI has acknowledged this growing concern by...
Persistent intraoperative leak Type 1A after stent implantation
Original title: Outcomes of persistent intraoperativa Type Ia endoleak after Standard endovascular aneurysm repair. Reference: Alistair Millen, et al. J. Vasc. Surg 2015;61:1185-91 The purpose of Endovascular Aneurysm Repair (EVAR) in the infrarenal abdominal aortic aneurysms (IAAA) is to prevent growth and rupture. Inadequate proximal seal by the stent favors the presence of leak type 1A that preserves...
New European Guidelines on the Management of Lower Limb Acute Ischemia
Clinical practice guidelines are usually tedious and, frankly, while a lot of people make an enormous effort to write them, they are ultimately read in full by just a few. These new European Guidelines on the Management of Lower Limb Acute Ischemia represent a special team effort, since they include physicians, cardiologists, surgeons, and interventionists,...
Bundle Branch Block and Need for Permanent Pacemaker, a Major Challenge after TAVR
Courtesy of Dr. Carlos Fava. The development of new valves for TAVR and the increased experienced of operators have significantly decreased paravalvular leak. However, new bundle Branch block (BBB) and the need for permanent pacemaker (PPM) are still relatively high, and their impact and evolution remain controversial. The study looked at 816 patients, 437...
TAVR Is Feasible and Offers Good Outcomes in Patients with Cancer
Courtesy of Dr. Carlos Fava. Oncology patients have been excluded from all studies, but many of them have a life expectancy of over a year or two, and aortic stenosis can pose a problem as regards their treatment. This study analyzed 2744 patients who underwent TAVR. Among them, 222 presented cancer (8.1%). Patients with cancer were younger,...
Aspirin During Noncardiac Surgery: Only in Patients with Prior Angioplasty
A new analysis from the POISE-2 study suggests that aspirin should not be withheld prior to noncardiac surgery in patients with a history of coronary angioplasty, even if their coronary procedure occurred several years earlier. Patients with a history of coronary angioplasty who need cardiac surgery are more likely to benefit from continued aspirin therapy,...
How Is Renal Function Affected by Endoprosthesis Implantation?
The occurrence of renal failure after any endovascular intervention is associated with increased morbility and mortality. After a coronary intervention (whether it be angioplasty or surgery), renal failure increases mortality 20-fold. Relatedly, surgical repair of an abdominal aortic aneurysm with renal failure is also associated with a significant increase in the number of events. Read...