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Surgical Findings and Outcomes of Endotension Following Endovascular Aneurysm Repair

 Seung Chul Han  ;  Joon Ho Kwon  ;  Hyun-Chel Joo  ;  Kichang Han  ;  Jung-Hwan Kim  ;  Sungmo Moon  ;  Gyoung Min Kim  ;  Man-Deuk Kim  ;  Jong Yun Won  ;  Young-Guk Ko 
 ANNALS OF VASCULAR SURGERY, Vol.80 : 264-272, 2022-03 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal / surgery* ; Blood Vessel Prosthesis Implantation / adverse effects ; Endoleak / diagnosis ; Endoleak / etiology* ; Endovascular Procedures / adverse effects* ; Humans ; Male ; Postoperative Complications / etiology* ; Retrospective Studies ; Stents
Background: Endotension is one of the detrimental complications after endovascular aneurysm repair (EVAR) and surgical management has been considered as standard of care. However, there is a paucity of data regarding the findings, and outcomes of such surgical intervention. The aim of this study was to investigate intraoperative findings and outcomes of surgical treatment for endotension after EVAR.

Methods: Between January 2005 and October 2018, of the 708 patients who underwent EVAR for aneurysm aortic aneurysm; 12 patients (mean age of 76.1; range 66-88) who underwent open repair for endotension were retrospectively analyzed. The anatomical characteristics of the aorta and surgical findings were reviewed. The rates of early and late procedural complications, and overall mortality were evaluated.

Results: The median interval between the EVAR and surgical conversion was 45.9 months (range 17.1-46.9). Three of the twelve patients underwent emergency surgery due to aneurysm rupture. The median aneurysm sac size, the proximal neck diameter, and the proximal neck length before EVAR were 64 mm, 23.5 mm, and 30.5 mm, respectively, that changed before open repair to 93.5 mm (P = 0.02), 25 mm (P = 0.011), and 23 mm (P = 0.003), respectively. In four of the twelve patients, radiographically undetected endoleak was identified during surgery to be Type Ia, Ib, II, and III, respectively. The rates of early and late procedural complications, and overall mortality were 8.3%, 8.3% and 8.3%, respectively.

Conclusions: Patients with endotension have a risk of delayed endoleak and aneurysm rupture; secondary intervention should be performed in such cases to prevent fatal complications. Surgical treatment appears to be a curative treatment for endotension with favorable outcomes. In addition, the possibility of an undetected endoleak should be considered as a potential cause of endotension.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kwon, Joon Ho(권준호) ORCID logo https://orcid.org/0000-0002-6178-7252
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Kim, Jung Hwan(김정환)
Moon, Sungmo(문성모)
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
Han, Ki Chang(한기창) ORCID logo https://orcid.org/0000-0002-9701-9757
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