Abdominal Aort Anevrizmasının Başarısız Endovasküler Tedavisi Sonrası Açık Cerrahi Onarım İle Tedavisi
Özet
Endovasküler aort anevrizması onarımı (EVAR) abdominal aort anevrizmalarının (AAA) tedavisinde açık cerrahi tekniklere alternatif olarak sıklıkla uygulanmaktadır. EVAR sonrası önemli komplikasyonlar kaçak (endoleak), stent greftin yer değiştirmesi, endotansiyon ve/veya kese genişlemesi, enfeksiyon, stent greft yırtığı ve kırığı, anevrizma rüptürüdür. Endovasküler tamire uygun olmayan kaçaklar, stent greft enfeksiyonu, anevrizma rüptürü ve stent greft trombozu gibi bazı kritik EVAR komplikasyonları için açık cerrahi onarıma dönüş, son basamak tedavi olarak kabul edilmektedir. Dolayısıyla bu yöntemlere hakimiyet, kardiyovasküler cerrahların klinik pratiğinde kritik önem arz eden ve üzerinde titizlikle durulması gereken bir konudur. Bu yazıda, EVAR sonrası erken açık cerrahi onarım uygulanan, 66 yaşında bir erkek olgunun yönetimi sunulmuştur.
Endovascular aortic aneurysm repair (EVAR) is frequently applied as an alternative to open surgical techniques in the treatment of abdominal aortic aneurysms (AAA). Crucial complications after EVAR are endoleak, stent graft migration, endotension and/or sac expansion, infection, stent graft rupture and fracture, and aneurysm rupture. For some critical EVAR complications such as endoleaks not amenable to endovascular repair, stent graft infection, aneurysm rupture, and stent graft thrombosis, conversion to open surgical repair is considered as the last-stage treatment. Therefore, mastery of these methods is a critical issue in the clinical practice of cardiovascular surgeons and should be meticulously emphasized. In this report, the management of a 66-year-old male patient who underwent early open surgical repair after EVAR is presented.
Referanslar
Klonaris C, Lioudaki S, Katsargyris A, Psathas E, Kouvelos G, Doulaptsis M, ve ark. Late open conversion after failed endovascular aortic aneurysm repair. Journal of Vascular Surgery. 2014 Feb;59(2):291-297
Mangialardi N, Ronchey S, Orrico M, Serrao E, Alberti V, Fazzini S, ve ark. Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement. Journal of Vascular Surgery. 2015 Dec;62(6):1437-1441
Brinster CJ, Fairman RM, Woo EY, Wang GJ, Carpenter JP, Jackson BM. Late open conversion and explantation of abdominal aortic stent grafts. Journal of Vascular Surgery. 2011 Jul;54(1):42-46
Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. European collaborators on stent/graft techniques for aortic aneurysm repair. Journal of Vascular Surgery. 2000 Oct;32(4):739-749
Lipsitz EC, Ohki T, Veith FJ, Suggs WD, Wain RA, Rhee SJ, ve ark. Delayed open conversion following endovascular aortoiliac aneurysm repair: Partial (or complete) endograft preservation as a useful adjunct. Journal of Vascular Surgery. 2003 Dec;38(6):1191-1198
Chaar CI, Eid R, Park T, Rhee RY, Abu-Hamad G, Tzeng E, ve ark. Delayed open conversions after endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery. 2012 Jun;55(6):1562-1569
Coppi G, GEnnai S, Saitta G. Treatment of ruptured abdominal aorta aneurysm after endovascular abdominal aortic repair. A comparison with patients without prior treatment. Journal of Vascular Surgery. 2009;49(3):582-588
Metha M, Paty PS, Roddy SP. Treatment options for delayed AAA rupture following endovascular repair. Journal of Vascular Surgery. 2011;53(1):14-20
Kelso RL, Lyden SP, Butler B, Greenberg RK, Eagleton MJ, Clair DG. Late conversion of aortic stent grafts. Journal of Vascular Surgery. 2009;49(3):589-595
Speziale F, Sbarigia E, Capoccia L, Menna D, Esposito A. Graft infection after EVAR. In: Pratesi C, Pulli R, editors. Management of Complications after EVAR and TEVAR. Torino: Edizioni Minerva Medica; 2012. pp. 224-236
Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: A review of causes, incidence, results, and surgical techniques of reconstruction. Journal of Endovascular Therapy. 2010 Dec;17(6):694-702. DOI: 10.1583/1545-1550-17.6.694. Review
Verzini F, Cao P, De Rango G, Parlani G, Xanthopoulos D, Iacono G, ve ark. Conversion to open repair after endografting for abdominal aortic aneurysm: Causes, incidence and results. European Journal of Vascular Surgery. 2006;31:136-142
Ferrero E, Ferri M, Viazzo A, Pecchio A, Berardi G, Piazza S, ve ark. Open conversion after endovascular aortic aneurysm repair: A single-center experience. Annals of Vascular Surgery. 2013 Oct;27(7):856-864
Perini P, de Troia A, Tecchio T, Azzarone M, Bianchini Massoni C, Salcuni P, ve ark. Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair. Journal of Vascular Surgery. 2017 Oct;66(4):1048-1055
Maitrias P, Kaladji A, Plissonnier D, Amiot S, Sabatier J, Coggia M, ve ark. Treatment of sac expansion after endovascular aneurysm repair with obliterating endoaneurysmorrhaphy and stent graft preservation. Journal of Vascular Surgery. 2016 Apr;63(4):902-908.
Turney EJ, Steenberge SP, Lyden SP, Eagleton MJ, Srivastava SD, Sarac TP, ve ark. Late graft explants in endovascular aneurysm repair. Journal of Vascular Surgery. 2014 Apr;59(4):886-893
Ouriel K, Clair DG, Greenberg RK, Lyden SP, Hara PJ, Sarac TP, ve ark. Endovascular repair of abdominal aortic aneurysms: Device-specific outcome. Journal of Vascular Surgery. 2003;37:991-998
White GH, May J, Waugh RC, Chaufour X, Yu W. Type III and type IV endoleak: Toward a complete definition of blood flow in the sac after endoluminal AAA repair. Journal of Endovascular Surgery. 1998;5:305-309
Fransen GA, Vallabhaneni SR Sr, van Marrewijk CJ, Laheij RJ, Harris PL, Buth J. Rupture of infra-renal aortic aneurysm after endovascular repair: A series from EUROSTAR registry. European Journal of Vascular and Endovascular Surgery. 2003;26:487-493
Referanslar
Klonaris C, Lioudaki S, Katsargyris A, Psathas E, Kouvelos G, Doulaptsis M, ve ark. Late open conversion after failed endovascular aortic aneurysm repair. Journal of Vascular Surgery. 2014 Feb;59(2):291-297
Mangialardi N, Ronchey S, Orrico M, Serrao E, Alberti V, Fazzini S, ve ark. Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sac enlargement. Journal of Vascular Surgery. 2015 Dec;62(6):1437-1441
Brinster CJ, Fairman RM, Woo EY, Wang GJ, Carpenter JP, Jackson BM. Late open conversion and explantation of abdominal aortic stent grafts. Journal of Vascular Surgery. 2011 Jul;54(1):42-46
Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. European collaborators on stent/graft techniques for aortic aneurysm repair. Journal of Vascular Surgery. 2000 Oct;32(4):739-749
Lipsitz EC, Ohki T, Veith FJ, Suggs WD, Wain RA, Rhee SJ, ve ark. Delayed open conversion following endovascular aortoiliac aneurysm repair: Partial (or complete) endograft preservation as a useful adjunct. Journal of Vascular Surgery. 2003 Dec;38(6):1191-1198
Chaar CI, Eid R, Park T, Rhee RY, Abu-Hamad G, Tzeng E, ve ark. Delayed open conversions after endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery. 2012 Jun;55(6):1562-1569
Coppi G, GEnnai S, Saitta G. Treatment of ruptured abdominal aorta aneurysm after endovascular abdominal aortic repair. A comparison with patients without prior treatment. Journal of Vascular Surgery. 2009;49(3):582-588
Metha M, Paty PS, Roddy SP. Treatment options for delayed AAA rupture following endovascular repair. Journal of Vascular Surgery. 2011;53(1):14-20
Kelso RL, Lyden SP, Butler B, Greenberg RK, Eagleton MJ, Clair DG. Late conversion of aortic stent grafts. Journal of Vascular Surgery. 2009;49(3):589-595
Speziale F, Sbarigia E, Capoccia L, Menna D, Esposito A. Graft infection after EVAR. In: Pratesi C, Pulli R, editors. Management of Complications after EVAR and TEVAR. Torino: Edizioni Minerva Medica; 2012. pp. 224-236
Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: A review of causes, incidence, results, and surgical techniques of reconstruction. Journal of Endovascular Therapy. 2010 Dec;17(6):694-702. DOI: 10.1583/1545-1550-17.6.694. Review
Verzini F, Cao P, De Rango G, Parlani G, Xanthopoulos D, Iacono G, ve ark. Conversion to open repair after endografting for abdominal aortic aneurysm: Causes, incidence and results. European Journal of Vascular Surgery. 2006;31:136-142
Ferrero E, Ferri M, Viazzo A, Pecchio A, Berardi G, Piazza S, ve ark. Open conversion after endovascular aortic aneurysm repair: A single-center experience. Annals of Vascular Surgery. 2013 Oct;27(7):856-864
Perini P, de Troia A, Tecchio T, Azzarone M, Bianchini Massoni C, Salcuni P, ve ark. Infrarenal endograft clamping in late open conversions after endovascular abdominal aneurysm repair. Journal of Vascular Surgery. 2017 Oct;66(4):1048-1055
Maitrias P, Kaladji A, Plissonnier D, Amiot S, Sabatier J, Coggia M, ve ark. Treatment of sac expansion after endovascular aneurysm repair with obliterating endoaneurysmorrhaphy and stent graft preservation. Journal of Vascular Surgery. 2016 Apr;63(4):902-908.
Turney EJ, Steenberge SP, Lyden SP, Eagleton MJ, Srivastava SD, Sarac TP, ve ark. Late graft explants in endovascular aneurysm repair. Journal of Vascular Surgery. 2014 Apr;59(4):886-893
Ouriel K, Clair DG, Greenberg RK, Lyden SP, Hara PJ, Sarac TP, ve ark. Endovascular repair of abdominal aortic aneurysms: Device-specific outcome. Journal of Vascular Surgery. 2003;37:991-998
White GH, May J, Waugh RC, Chaufour X, Yu W. Type III and type IV endoleak: Toward a complete definition of blood flow in the sac after endoluminal AAA repair. Journal of Endovascular Surgery. 1998;5:305-309
Fransen GA, Vallabhaneni SR Sr, van Marrewijk CJ, Laheij RJ, Harris PL, Buth J. Rupture of infra-renal aortic aneurysm after endovascular repair: A series from EUROSTAR registry. European Journal of Vascular and Endovascular Surgery. 2003;26:487-493
