Challenging the limits of endovascular abdominal aortic aneurysm repair

188 Pages·2015·6.71 MB·English

Challenging the limits of endovascular
abdominal aortic aneurysm repair
Pieter Petrus Henricus Luciën Broos
Financial support by the Dutch Heart Foundation for the publication of this
thesis is gratefully acknowledged.
Additional financial support was generously provided by; Catharina Ziekenhuis
Eindhoven, Fonds voor het hart, W.L. Gore & Associates, Rabobank Eindhoven-
Veldhoven, Krijnen Medical Innovations, Pie Medical Imaging.
Challenging the limits of endovascular abdominal aortic aneurysm repair
Thesis, University of Maastricht, The Netherlands
Copyright © 2015 Pieter Broos, The Netherlands
No part of this thesis may be reproduced, stored or transmitted without prior
permission of the author.
Lay-out Eric Alberts, ericalberts.com
Printed by Ridderprint, Ridderkerk, The Netherlands
ISBN 978-94-6299-225-2
Challenging the limits of endovascular
abdominal aortic aneurysm repair
PROEFSCHRIFT
ter verkrijging van de graad van doctor
aan de Universiteit Maastricht,
op gezag van Rector Magnificus, prof. dr. L.L.G. Soete
volgens het besluit van het College van Decanen,
in het openbaar te verdedigen
op dinsdag 8 december 2015 om 16.00 uur
door
Pieter Petrus Henricus Luciën Broos
geboren te Oosterhout op 20 februari 1987
Promotiecommissie
Promotor
Prof. dr. J.A.W. Teijink
Copromotoren
Dr. M.R.H.M. van Sambeek (Catharina Ziekenhuis, Eindhoven)
Dr. Ph.W.M. Cuypers (Catharina Ziekenhuis, Eindhoven)
Beoordelingscommissie
Prof. dr. M.H. Prins (voorzitter)
Prof. dr. F.L. Moll (Universitair Medisch Centrum Utrecht, Utrecht)
Prof. dr. G.W.H. Schurink
Prof. dr. H.J.M. Verhagen (Erasmus Medisch Centrum, Rotterdam)
Voor An en Lola
Contents
Chapter 1 General introduction and outline of the thesis 9
PART ONE Evolution and long-term follow-up in EVAR patients 21
Chapter 2 Ten-year follow-up of talent stent grafts for endovascular 21
abdominal aortic aneurysm repair: a single-centre
experience
Chapter 3 Long-term outcome of endovascular repair for elective and 37
ruptured abdominal aortic aneurysms; 15-year single centre
experience
PART TWO Clinical experience and new insights in EVAR 57
Chapter 4 The effects of anesthesia type on perioperative outcome 57
after endovascular aneurysm repair
Chapter 5 A ruptured abdominal aortic aneurysm requiring 75
preoperative cardiopulmonary resuscitation is not
necessarily lethal
PART THREE Challenging anatomy in EVAR 91
Chapter 6 Endovascular treatment of ruptured abdominal aortic 91
aneurysms with hostile aortic neck anatomy
Chapter 7 Performance of the endurant stent graft in challenging 109
anatomy: 30-day and 1-year analyses
Chapter 8 Rationale and design of the eagle registry: EVAR with the 129
endurant in challening anatomy
PART FOUR Summary, general discussion and future perspectives 143
Chapter 9 Summary, general discussion and future perspectives 143
Chapter 10 Nederlandse samenvatting 155
Appendices Valorisatie addendum 167
Dankwoord 173
Curriculum vitae 181
List of publications 185

Chapter 1
General introduction and outline
of the thesis
Partly published as
Endovascular aneurysm repair in challenging anatomy
P.P.H.L. Broos
1
R.A. Stokmans
B.L.W. Bendermacher
Ph.W.M. Cuypers
M.R.H.M. van Sambeek
J.A.W. Teijink
Aortic Aneurysms: Risk factors, diagnosis, surgery & repair. New York: Nova
Science Publishers, 2013, ISBN: 978-1-62618-458-9
10 Chapter 1
General introduction
Abdominal aortic aneurysms
An abdominal aortic aneurysm is a localised, permanent dilatation of the
abdominal aorta that exceeds the normal diameter by more than 50 percent.
Abdominal aortic aneurysms (AAAs) are a significant health challenge with
an estimated incidence of 20-40 cases per 100 000 population per year. Initial
treatment is aimed at preventing rupture.1,2 There is a generally accepted indication
for treatment if the threshold diameter of the AAA is reached (55 mm/50 mm,
measured by ultrasonography, in males/females respectively), if rapid aneurysm
growth is observed (> 5 mm / 6 months), or if the aneurysm becomes symptomatic.3
Open aneurysm repair
Since its first introduction in 1952 by Dubost et al., open aneurysm repair has
undergone many improvements and has become the gold standard of AAA
treatment.4 Based on long-term follow-up data, open repair remains a safe
and durable option for the management of AAAs.5 However, open surgical
aneurysm repair requires laparotomy and clamping of the aorta, which is
frequently accompanied by substantial blood loss. Consequently, open repair is
still associated with a perioperative mortality rate of 2% to 5% and significant
morbidity.
Endovascular aneurysm repair (EVAR)
Over the last 25 years, the management of AAAs has changed dramatically.
Independently of each other, Parodi et al. and Volodos et al. introduced endovascular
aneurysm repair (EVAR) in 1991.6,7 Under X-ray fluoroscopic guidance, a minimally
invasive approach is used to introduce a stent graft into the abdominal aorta
and exclude the aneurysm sac from circulation. Initially, EVAR was an alternative
treatment for patients with severe comorbidities, who were not suitable for open
repair. Currently, however, EVAR has become the preferred treatment option for
patients with an AAA in many centres. However, the main downside of EVAR is the
risk of late complications and the subsequent need for secondary interventions.8