Update On Endoluminal Grafting To Exclude Abdominal
http://www.100md.com
2001年10月4日
Update on Endoluminal Grafting to Exclude Abdominal
Edward B. Diethrich, MD
Medical Director and Chief of Cardiovascular and Endovascular Surgery,
Arizona Heart Institute and Arizona Heart Hospital,Phoenix, Arizona
Nearly a decade after the first successful case of endovascular exclusion of an abdominal aortic aneurysm (AAA), the Food and Drug Administration (FDA) approved two devices for use in the United States. For the corporate world, this event was a monumental achievement after years of research and millions of dollars invested.
, http://www.100md.com
For physicians, the access to commercially prepared devices sanctioned by the FDA has made it easier to bring this technology to their patients, who will think it nothing short of miraculous. Despite severe comorbidities that would either preclude or greatly increase their risk of classical operation, patients will receive the potential life-saving benefit of endovascular grafting with minimal discomfort and low procedural complications.
At the Arizona Heart Institute and Hospital, more than 600 endografts have been implanted in one form or another in various anatomical and pathological situations since our program began more than 7 years ago. Based on our periprocedural and follow-up observations, as well as personal communications from investigators worldwide, endovascular graft technology has moved into its adolescence.
, 百拇医药
Unfortunately, there are few long-term results published, and those that are feature first-generation or homemade devices. However, these outcomes are providing useful data for the device manufacturers. Comparative studies are already underway at individual centers, and multicenter trials of endograft technology versus the gold standard of resection and graft replacement will commence soon.
What is on the horizon for the next decade? The technology will continue to improve. So significant will be the developmental refinements that the two currently approved devices will be unrecognizable in their fourth-generation iterations. Four
, 百拇医药
or more corporate-sponsored endografts will clear the approval process soon, and the problems associated with this procedure will be either partially or completely resolved. Patient exclusion based on either anatomicopathological or device deficiencies will be minimized. In short, endovascular grafting will be the new gold standard for exclusion of aortic aneurysms!
BIBLIOGRAPHY
1. Beebe HG, Kritpracha B, Serres S, et al. Endograft planning without preoperative arteriography: a clinical feasibility study. J Endovasc Ther. 2000;7:8-15.
, 百拇医药
2. Buth J, Laheij RJF, on behalf of the EUROSTAR Collaborators. Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: report of a multicenter study. J Vasc Surg. 2000;31:134-146.
3. Chuter TAM, Reilly LM, Faruqi RM, et al. Endovascular aneurysm repair in high-risk patients. J Vasc Surg. 2000;31:122-133.
4. Chuter TAM, Reilly LM. Aortomonoiliac endovascular grafting combined with femorofemoral bypass: an acceptable compromise or a preferred solution? Semin Vasc Surg. 1999;12:176-181.
, http://www.100md.com
5. Clair DG, Gray B, O’Hara PJ, Ouriel K. An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair. J Vasc Surg. 2000;32:148-152.
6. Cohnert TU, Oelert F, Wahlers T, et al. Matched-pair analysis of conventional versus endoluminal AAA treatment outcomes during the initial phase of an aortic endografting program. J Endovasc Ther. 2000;7:94-100.
7. Cuyers P, Buth J, Harris PL, et al. Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European Douville Y, et al. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR registry. J Endovasc Ther. 2000;7:105-122.
, http://www.100md.com
8. Faruqi RM, Chuter TAM, Reilly LM, et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6:354-358.
9. Franko TJ, Zajko AB, Federle MP, Makaroun MS. Endovascular repair of abdominal aortic aneurysm with the Ancure endograft: CT follow-up of perigraft flow and aneurysm size at 6 months. J Vasc Interv Radiol. 2000;11:429-435.
10. Gilling-Smith G, Martin J, Sudhindran S, et al. Freedom from endoleak after endovascular aneurysm repair does not equal treatment success. Eur J Vasc Endovasc Surg. 2000;19:421-425.
, 百拇医药
11. Greenberg RK, Srivastava SD, Ouriel K, et al. An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms. J Endovasc Ther. 2000;7:1-7.
12. Guidoin R, Marois Y, Douville Y, et al. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR registry. J Endovasc Ther. 2000;7:105-122.
13. Lobato AC, Quick RC, Vaughn PL, et al. Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience. J Endovasc Ther. 2000;7:273-278.
, http://www.100md.com
14. May J, White GH, Waugh R, et al. Comparison of first- and second-generations prostheses for endoluminal repair of abdominal aortic aneurysms: a 6-year study with life table analysis. J Vasc Surg. 2000;32:124-129.
15. Myers KA. Commentary: How will endoluminal grafting for aneurysms be judged? J Endovasc Ther. 2000;7:101-104.
16. Ohki T, Veith FJ. Patient selection for endovascular repair of abdominal aortic aneurysms: changing the threshold for intervention. Semin Vasc Surg. 1999;12:226-234.
, 百拇医药
17. Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases. J Vasc Surg. 2000;31:599-606.
18. Resch T, Ivancev J, Brunkwall J, et al. Midterm changes in aortic aneurysm morphology after endovascular repair. J Endovasc Ther. 2000;7:279-285.
19. Schunn CD, Krauss M, Heilberger P, et al. Aortic aneurysm size and graft behavior after endovascular stent-grafting: clinical experiences and observations over 3 years. J Endovasc Ther. 2000;7:167-176.
, http://www.100md.com
20. Sternbergh WC III, Money SR. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study. J Vasc Surg. 2000;31:237-244.
21. Walker SR, Macierewicz J, Hopkinson BR. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge. J Endovasc Surg. 1999;6:350-353.
22. White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg.1999;6:308-315.
, 百拇医药
23. White RA, Donayre C, Walot I, Stewart M. Abdominal aortic aneurysm rupture following endoluminal graft deployment: report of a predictable event. J Endovasc Ther. 2000;7:257-262.
24. Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg. 2000;32:90-107.
25. Zarins CK, White RA, Fogarty TJ. Aneurysm rupture after endovascular repair using the AneuRx stent graft. J Vasc Surg. 2000;31:960-970.
26. Zarins CK, White RA, Schwarten D, et al. AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg. 1999; 29:292-308., 百拇医药
Edward B. Diethrich, MD
Medical Director and Chief of Cardiovascular and Endovascular Surgery,
Arizona Heart Institute and Arizona Heart Hospital,Phoenix, Arizona
Nearly a decade after the first successful case of endovascular exclusion of an abdominal aortic aneurysm (AAA), the Food and Drug Administration (FDA) approved two devices for use in the United States. For the corporate world, this event was a monumental achievement after years of research and millions of dollars invested.
, http://www.100md.com
For physicians, the access to commercially prepared devices sanctioned by the FDA has made it easier to bring this technology to their patients, who will think it nothing short of miraculous. Despite severe comorbidities that would either preclude or greatly increase their risk of classical operation, patients will receive the potential life-saving benefit of endovascular grafting with minimal discomfort and low procedural complications.
At the Arizona Heart Institute and Hospital, more than 600 endografts have been implanted in one form or another in various anatomical and pathological situations since our program began more than 7 years ago. Based on our periprocedural and follow-up observations, as well as personal communications from investigators worldwide, endovascular graft technology has moved into its adolescence.
, 百拇医药
Unfortunately, there are few long-term results published, and those that are feature first-generation or homemade devices. However, these outcomes are providing useful data for the device manufacturers. Comparative studies are already underway at individual centers, and multicenter trials of endograft technology versus the gold standard of resection and graft replacement will commence soon.
What is on the horizon for the next decade? The technology will continue to improve. So significant will be the developmental refinements that the two currently approved devices will be unrecognizable in their fourth-generation iterations. Four
, 百拇医药
or more corporate-sponsored endografts will clear the approval process soon, and the problems associated with this procedure will be either partially or completely resolved. Patient exclusion based on either anatomicopathological or device deficiencies will be minimized. In short, endovascular grafting will be the new gold standard for exclusion of aortic aneurysms!
BIBLIOGRAPHY
1. Beebe HG, Kritpracha B, Serres S, et al. Endograft planning without preoperative arteriography: a clinical feasibility study. J Endovasc Ther. 2000;7:8-15.
, 百拇医药
2. Buth J, Laheij RJF, on behalf of the EUROSTAR Collaborators. Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: report of a multicenter study. J Vasc Surg. 2000;31:134-146.
3. Chuter TAM, Reilly LM, Faruqi RM, et al. Endovascular aneurysm repair in high-risk patients. J Vasc Surg. 2000;31:122-133.
4. Chuter TAM, Reilly LM. Aortomonoiliac endovascular grafting combined with femorofemoral bypass: an acceptable compromise or a preferred solution? Semin Vasc Surg. 1999;12:176-181.
, http://www.100md.com
5. Clair DG, Gray B, O’Hara PJ, Ouriel K. An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair. J Vasc Surg. 2000;32:148-152.
6. Cohnert TU, Oelert F, Wahlers T, et al. Matched-pair analysis of conventional versus endoluminal AAA treatment outcomes during the initial phase of an aortic endografting program. J Endovasc Ther. 2000;7:94-100.
7. Cuyers P, Buth J, Harris PL, et al. Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European Douville Y, et al. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR registry. J Endovasc Ther. 2000;7:105-122.
, http://www.100md.com
8. Faruqi RM, Chuter TAM, Reilly LM, et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6:354-358.
9. Franko TJ, Zajko AB, Federle MP, Makaroun MS. Endovascular repair of abdominal aortic aneurysm with the Ancure endograft: CT follow-up of perigraft flow and aneurysm size at 6 months. J Vasc Interv Radiol. 2000;11:429-435.
10. Gilling-Smith G, Martin J, Sudhindran S, et al. Freedom from endoleak after endovascular aneurysm repair does not equal treatment success. Eur J Vasc Endovasc Surg. 2000;19:421-425.
, 百拇医药
11. Greenberg RK, Srivastava SD, Ouriel K, et al. An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms. J Endovasc Ther. 2000;7:1-7.
12. Guidoin R, Marois Y, Douville Y, et al. First-generation aortic endografts: analysis of explanted Stentor devices from the EUROSTAR registry. J Endovasc Ther. 2000;7:105-122.
13. Lobato AC, Quick RC, Vaughn PL, et al. Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience. J Endovasc Ther. 2000;7:273-278.
, http://www.100md.com
14. May J, White GH, Waugh R, et al. Comparison of first- and second-generations prostheses for endoluminal repair of abdominal aortic aneurysms: a 6-year study with life table analysis. J Vasc Surg. 2000;32:124-129.
15. Myers KA. Commentary: How will endoluminal grafting for aneurysms be judged? J Endovasc Ther. 2000;7:101-104.
16. Ohki T, Veith FJ. Patient selection for endovascular repair of abdominal aortic aneurysms: changing the threshold for intervention. Semin Vasc Surg. 1999;12:226-234.
, 百拇医药
17. Politz JK, Newman VS, Stewart MT. Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases. J Vasc Surg. 2000;31:599-606.
18. Resch T, Ivancev J, Brunkwall J, et al. Midterm changes in aortic aneurysm morphology after endovascular repair. J Endovasc Ther. 2000;7:279-285.
19. Schunn CD, Krauss M, Heilberger P, et al. Aortic aneurysm size and graft behavior after endovascular stent-grafting: clinical experiences and observations over 3 years. J Endovasc Ther. 2000;7:167-176.
, http://www.100md.com
20. Sternbergh WC III, Money SR. Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study. J Vasc Surg. 2000;31:237-244.
21. Walker SR, Macierewicz J, Hopkinson BR. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge. J Endovasc Surg. 1999;6:350-353.
22. White GH, May J, Petrasek P, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg.1999;6:308-315.
, 百拇医药
23. White RA, Donayre C, Walot I, Stewart M. Abdominal aortic aneurysm rupture following endoluminal graft deployment: report of a predictable event. J Endovasc Ther. 2000;7:257-262.
24. Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg. 2000;32:90-107.
25. Zarins CK, White RA, Fogarty TJ. Aneurysm rupture after endovascular repair using the AneuRx stent graft. J Vasc Surg. 2000;31:960-970.
26. Zarins CK, White RA, Schwarten D, et al. AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg. 1999; 29:292-308., 百拇医药